CN106420120A

CN106420120A - Stemless humeral component of an orthopaedic shoulder prosthesis

Info

Publication number: CN106420120A
Application number: CN201610645547.6A
Authority: CN
Inventors: K.L.詹森; J.P.伊安诺蒂; 劳伦特·赞琴; 安德斯·埃克隆德; 马修·T·斯通; 杰里迈亚·M·刘易斯; S.安东尼; J.F.朗; D.庞塞特; D.M.瓦洛普; C.劳伦斯; S.A.卢本斯基
Original assignee: DePuy Products Inc
Current assignee: DePuy Products Inc; DePuy Synthes Products Inc
Priority date: 2012-03-30
Filing date: 2013-03-14
Publication date: 2017-02-22
Anticipated expiration: 2033-03-14
Also published as: AU2017204609A1; US20160030197A1; CN104540476A; US20190015222A1; CN106667543B; EP2830541A1; JP2015516835A; US20160058561A1; US9700436B2; US9161843B2; ES2598054T3; US20140188231A1; EP3146940A1; EP2959867B1; AU2017204612B2; JP6430579B2; EP2830541B1; CN106308874A; WO2013148229A1; US10034777B2

Abstract

A stemless humeral component for replacing the humeral head of a patient's humerus includes a support flange having a number of cantilevered legs extending distally away from a bottom surface thereof. Instruments and methods for surgically installing the stemless humeral component are also disclosed.

Description

No bar humeral component and related surgical instruments and method

The application is to be on March 14th, 2013, Application No. 201380028615.9, invention entitled " no bar the applying date The divisional application of the Chinese patent application of the surgical instruments of humeral component and correlation and method ".

The Serial No. 61/618,385 and 61/618,389 that patent application claims are all submitted on March 30th, 2012 The priority of U.S. Provisional Application, this two provisional application are herein incorporated by reference.

Technical field

The disclosure relates generally to orthopaedic implants, apparatus and surgical method, and relates more specifically to plastic surgery The no bar humeral component of shoulder implant, and its surgical instruments of correlation and method.

Background technology

In patient in life, because (such as) disease or wound reason are it may be necessary to carry out shoulder displacement to patient Operation.The natural head of the humerus of patient in shoulder replacement operation, is replaced using artificial body of the humerus.Artificial body of the humerus generally includes Elongation rod unit in the intermedullary canal of the humerus being implanted to patient and the substantially semi-spherical prosthesis head being fixed on this rod unit Part.In some shoulder replacement operations, the natural joint broad-mouthed receptacle for holding liquid surface of shoulder blade can be using the glenoid cavity portion providing supporting surface Line replacement is rebuild or in other words entered to part, and the wherein prosthese head piece of artificial body of the humerus can be carried out in described supporting surface Joint motions.

Content of the invention

According on one side, no bar humeral component is used as the substitute of conventional humerus im rod part.So, the no bar upper arm Osteogenic section with acting on the mounting structure of humeral head part, it is done so that when do not need such as the feelings of conventional humerus rod unit Condition removes bone tissue from the intramedullary canal of the humerus of patient like that.

In one embodiment, no bar humeral component includes support lugn, this support lugn have distally extending away from Multiple cantilevered legs of its lower surface.When in terms of bottom front view, each leg can be generally T-shaped.

No bar humeral component can have and is formed at multiple watch window therein, prepared with allowing surgeon to observe surgery Humeral surface (i.e. surface produced by surgical excision humeral head), so that it is guaranteed that no bar humeral component is in its implant surgical phase Between complete seating.No bar humeral component can have and is formed at multiple correction slit therein, and these are revised slits and allow surgeries doctor Raw transmission osteotome or other cutting device, to cut or in other words to destroy bone uptake, are thus conducive to moving during revisional operation Remove no bar humeral component.

No bar humeral component may also include the elongation sleeve of the distally extending lower surface away from its support lugn.Sleeve Can have and be formed at taper bore therein.The tapered stud of humeral head part can be plugged into and is pressed to further afterwards No in the taper bore of elongation sleeve of bar humeral component, humeral head part is conically locked onto no bar humeral component.

According on the other hand, impact shank can be used for implanting the surgical operation of no bar humeral component.Impact shank includes Attachment means, this attachment means allow shank be fixed to implantation use no during the surgical operation of bar humeral component multiple not Same apparatus.

According on the other hand, be aligned shank can be used for implanting the surgical operation of no bar humeral component.Similar to impact handle Portion, be aligned shank includes attachment means, and this attachment means allows shank to be fixed to the surgical operation in implantation no bar humeral component Multiple difference apparatuses that period uses.

According on the other hand, sizing apparatus can be used for implanting the surgical operation of no bar humeral component.Sizing apparatus is big Body is dome-shaped, and can be fixed to the humerus table that the surgery of patient prepares during the implantation no surgical operation of bar humeral component Face, for use as sizing test and drift and brill guide.

According on the other hand, test head part is commented for cooperation during the implantation no surgical operation of bar humeral component Estimate.It also acts as the test apparatus for humeral head part, and equally includes substantially hemisphere body.Test head portion Part also acts as brill guide, and for guiding drill bit, this drill bit is used for holing on the humeral surface that the surgery of patient prepares (or prebored hole), to receive the leg of no bar humeral component.

According on the other hand, surgery drift can be used to punching in the humeral surface that surgery prepares, to receive the no bar upper arm The leg of osteogenic section.In one embodiment, surgery drift is substantially fork-shaped, and includes multiple pointed tooths, and these pointed tooths exist Corresponding with the leg of no bar humeral component on shape, size and position.

According on the other hand, center bit can be used in the humeral surface that the surgery of patient prepares boring (or preboring Hole), to receive the elongation sleeve of no bar humeral component.On the other hand, Periphery bit can be used to the upper arm preparing in the surgery of patient Hole (or prebored hole) in bone surface, to receive the leg of no bar humeral component.

According on the other hand, adjustable head resection guide can be used as cutting guiding piece, to guide bone saw blade Propulsion, thus excise the humeral head of patient.Head resection guide may include the static cutting guiding piece of fixing arch and Movable cutting guiding piece, this movable cutting guiding piece can be transported along court with away from the direction of static cutting guiding piece Dynamic.So, adjustable head resection guide can be used as the apparatus of common-use size.

According on the other hand, uncontrollable head resection guide can be used as cutting guiding piece, to guide bone saw knife Piece advances, thus excising the humeral head of patient.Head resection guide may include the base portion of general rectangular, and this base portion has solid The fixed circular rings arriving thereon.This ring can stretch out from base portion, and limits circular open.The humeral head of patient is in the excision phase Between can be captured in the openings.

According on the other hand, implant inserts the surgery that instrument can be used to be conducive to no bar humeral component to be implanted to patient In the humeral surface preparing.In one embodiment, implant insertion instrument is used as " quick connection " apparatus, this quick connector Tool has locked, and in latched position, no bar humeral component locks onto on this apparatus, in unlocked position In, no bar humeral component discharges from this apparatus.In another embodiment, implant insertion instrument may include securing rod, this lock Fixed pole is configured to be threadably engaged with no bar humeral component.In another embodiment, implant insertion instrument May include and be configured to engage the no screw tip of bar humeral component and be dimensioned so as to receive impact shank The hole of connecting pin.In another embodiment, implant insertion instrument may include be configured to no bar humeral component with The securing rod and being dimensioned so as to that engagement thread engages receives the hole of the connecting pin of impact shank.

According on the other hand, head impact instrument can be utilized for impacting, and thus conically locks onto head piece No bar humeral component.Head impact instrument may include the concave impulse surface of circle, the size of this shock surface, shape and position It is set as conforming closely with convex, the substantially hemispheric outer surface of head piece.

Brief description

It is described in detail referring especially to the following drawings, wherein：

Fig. 1 is the middle perspective view of no bar humeral component；

Fig. 2 is the lateral perspective of the no bar humeral component of Fig. 1；

Fig. 3 is the middle front view of the no bar humeral component of Fig. 1；

Fig. 4 is the side elevation of the no bar humeral component of Fig. 1；

Fig. 5 is the amplification profile of the no bar humeral component seen in the direction of the arrow of the line 5-5 intercepting along Fig. 3；

Fig. 6 is the perspective view of impact shank, and this impact shank can be used for implanting the surgery hand of the no bar humeral component of Fig. 1 Art；

Fig. 7 is the profile of the impact shank observed in the direction of the arrow of the line 7-7 intercepting along Fig. 6；

Fig. 8 is the perspective view of be aligned shank, and this be aligned shank can be used for implanting the surgery hand of the no bar humeral component of Fig. 1 Art；

Fig. 9 is the cross-sectional view of the be aligned shank observed in the direction of the arrow of the line 9-9 intercepting along Fig. 8；

Figure 10 is the middle perspective view of sizing apparatus, and this sizing apparatus can be used for implanting the outer of the no bar humeral component of Fig. 1 Section performs the operation；

Figure 11 is the lateral perspective of the sizing part of Figure 10；

Figure 12 and 13 is the perspective view of test head part, and this test head part can be used for implanting the no bar humerus of Fig. 1 The surgical operation of part；

Figure 14 is the perspective view of surgery drift, and this surgery drift can be used for implanting the surgery hand of the no bar humeral component of Fig. 1 Art；

The front view boring centered on Figure 15, this centre drill can be used for implanting the surgical operation of the no bar humeral component of Fig. 1；

The front view that Figure 16 bores for periphery, this periphery bores the surgical operation that can be used for the no bar humeral component implanting Fig. 1；

Figure 17 is the perspective view of head resection guide, and this head resection guide can be used for implanting the no bar humerus of Fig. 1 The surgical operation of part；

Figure 18 and 19 is the side front view of the head resection guide of Figure 17；

Figure 20 and 21 inserts the perspective view of instrument for implant, and this implant inserts instrument and can be used for implanting the no bar of Fig. 1 The surgical operation of humeral component；

The implant for Figure 20 and 21 for the Figure 22 inserts the end elevation view of instrument, shows and is positioned in its unlocked position Implant inserts instrument；

Figure 23 is the view similar with Figure 22, but shows the implant insertion instrument being positioned in its latched position；

Figure 24 is the fragmentary, perspective view of head impact instrument, and this head impact instrument can be used for implanting the no bar humerus of Fig. 1 It is noted that for the sake of clarity, a part for head impact instrument is already cut off the surgical operation of part；

Figure 25 and 26 is the perspective view of the head resection guide of the humeral head of the humerus for excising patient；

Figure 27 is the perspective view being arranged on the sizing apparatus on the removed humeral head of patient using be aligned shank；

Figure 28 is the perspective view of the test head part being arranged on sizing apparatus；

Figure 29 and 30 is the perspective view of the surgery drift of punching in the surgery preparation surface of the humerus in patient；

Figure 31 and 32 is the perspective view of the surgical drill of boring in the surgery preparation surface of the humerus in patient；

Figure 33 and 34 is that the surgery of the humerus being implanted to patient for the no bar humeral component by Fig. 1 prepares the plant in surface Enter the perspective view that thing inserts instrument；

Figure 35 is the perspective view of the head impact instrument in the no bar humeral component that head piece is installed to implantation；

Figure 36 is the partial cross section view of the head piece in the no bar humeral component be arranged on implantation；

Figure 37 is the perspective view that another implant inserts instrument, and this implant inserts instrument and can be used for implanting the nothing of Fig. 1 The surgical operation of bar humeral component；

Figure 38 is the perspective view that different implants insert instrument, and this implant inserts instrument and can be used for implanting the nothing of Fig. 1 The surgical operation of bar humeral component；

Figure 39 and 40 inserts the perspective view of instrument for another implant, and this implant insertion instrument can be used for implanting Fig. 1 No bar humeral component surgical operation；

Figure 41 and 42 is the perspective view of another head resection guide, and this head resection guide can be used for implanting Fig. 1 No bar humeral component surgical operation；

Figure 43 is the middle perspective view of no another embodiment of bar humeral component；

Figure 44 is the lateral perspective of the no bar humeral component of Figure 43；

Figure 45 is the middle perspective view of another embodiment of sizing apparatus, and this sizing apparatus can be used for implanting the nothing of Fig. 1 The surgical operation of bar humeral component；

Figure 46 is the lateral perspective of the sizing part of Figure 45；

Figure 47 is the perspective view of another embodiment of surgery drift, and this surgery drift can be used for implanting the no bar upper arm of Fig. 1 The surgical operation of osteogenic section；

Figure 48 is the perspective view that another implant inserts instrument, and this implant inserts instrument and can be used for implanting the nothing of Fig. 1 The surgical operation of bar humeral component；

Figure 49 is the perspective view boring guide, and this brill guide can be used for implanting the surgery hand of the no bar humeral component of Fig. 1 Art；

Figure 50 is the vertical frontal view of the brill guide of Figure 49；

Figure 51 is the bottom front view of the brill guide of Figure 49；And

Figure 52 is can be with the perspective view of another embodiment boring the sizing apparatus that guide is used in combination of Figure 49-51.

Specific embodiment

Although the concept of the disclosure is easily affected by various modification and alternate forms, the disclosure specific illustrative Embodiment illustrates in the accompanying drawings by way of example, and will herein be described in detail.It should be appreciated, however, that being not intended to herein Idea of the invention is limited to disclosed concrete form, but on the contrary, it is an object of the invention to cover falling into the present invention Spirit and scope in all modifications form, equivalents and alternate forms.

Natural anatomic part about orthopedic implants as herein described and patient employs expression and dissects in the disclosure Learn the term of reference, for example before, below, middle, side, upper and lower etc..These terms are outside anatomy and shaping Section field is respectively provided with known implication.Except as otherwise noted, otherwise such anatomical reference used in description and claims Term is intended to meet implication known to it.

With reference now to Fig. 1-5, it illustrates no bar humeral component 10.As described in more detail below, no bar humerus portion Part 10 is used as the substitute of conventional humerus intramedullary injection rod unit.So, no bar humeral component 10 is with acting on humeral head portion The mounting structure (referring to Figure 35 and 36) of part 12, it is done so that when do not need as the situation of conventional humerus rod unit from The intramedullary canal of the humerus of patient removes bone tissue.

No bar humeral component 10 includes support lugn 14, this support lugn have distally extending away from its lower surface 18 Multiple legs 16.In exemplary embodiment as herein described, support lugn 14 is circular in shape.Support lugn 14 Top surface 20 include annular skewed surface 22.Annular ring 24 extends around the periphery of the skewed surface 22 of support lugn.Annular Ring 24 has and is formed at multiple sewing hole 26 therein.Sewing hole 26 can be used to osteocomma or suturing soft tissue to no bar humerus Part 10.For example, osteocomma is harvested by the rotation muscle group around patient, then such osteocomma is sewn onto no using sewing hole 26 Bar humeral component 10, can retain the natural attachment of the rotation muscle group of patient.

Also have in the annular ring 24 of support lugn and be formed at multiple correction slit 28 therein.Can see in figures 1 and 4 Arrive, revise one of slit 28 and be positioned on annular ring 24 at the position above each in leg 16, and from leg Each in 16 extends radially outward.So, osteotome or other cutting device may pass through correction slit to cut or in other words Say the osteoclastic growth towards leg 16, consequently facilitating removing no bar humeral component 10 during revisional operation.

Also have in support lugn 14 and be formed at multiple watch window 30 therein.Watch window 30 allows surgeon to see Examine the humeral surface (i.e. surface produced by surgical excision humeral head) of surgery preparation, so that it is guaranteed that no bar humeral component 10 exists Complete seating during its Srgery grafting.It should be appreciated that watch window 30 also acts as extra correction slit, surgeon can make Osteotome or other cutting device pass through this correction slit to cut or the in other words osteoclastic growth towards leg 16, thus just In removing no bar humeral component 10 during revisional operation.

Fig. 2 and 5 can see, elongation sleeve 36 along distally extending with the direction that leg 16 is substantially the same away from The lower surface 18 of support lugn 14.Sleeve 36 includes tapered distal end 38, and this tapered distal end is used as leading-in end, so that In be inserted into patient surgery prepare humeral surface (i.e. surface produced by surgical excision humeral head) in get out or In other words in the hole being formed.Elongation sleeve 36 has and is formed at taper bore 40 therein.Tapered stud 42 extends laterally to Back surface (the i.e. side with the substantially hemispheric external support surface opposite pair of humeral head part of humeral head part 12 Face) outside, and receive in the taper bore 40 of elongation sleeve 36 of no bar humeral component (referring to Figure 36).As following more detailed Carefully describe, the tapered stud 42 of humeral head part 12 is forced into and defines the taper bore 40 of elongation sleeve 36 Humeral head part 12 taper can be locked onto no bar humeral component 10 by sidewall contact.In fig. 5 it may be seen that taper bore Lead to the top surface 20 of support lugn 14 for 40 upper end 44, and threaded bore is led in the distal lower end portion 46 of taper bore 40 48.The distally extending distal end 46 away from taper bore 40 of threaded bore 48, and lead to the distal end portion of elongation sleeve 36 Portion 38.In fig. 5 it may be seen that have in the side wall defining threaded bore 48 being formed at multiple screw thread 50 therein.Screw thread 50 be dimensioned so as to coupling and thus threadably receive implant retraction tool (not shown) or as more fully below The implant of ground description inserts the screw thread of instrument.

Fig. 2,4 and 5 can be seen, each in leg 16 is cantilevered, therefore one end is fixed to and props up The lower surface 18 of support flange 14, the other end of leg 16 is freely (to be not affixed to support lugn 14, any other leg Any other structure of portion 16 or no bar humeral component 10).It can further be seen that working as from bottom front view (i.e. in Fig. 2,4 and 5 View with the longitudinal axis orthogonal of leg 16) when observing, each in leg 16 is generally T-shaped, and it is horizontal therefore to have T-shaped To cross section (cross section with intercepting in the plane of the longitudinal axis orthogonal of leg).In such arrangement, in leg 16 Each has osteosynthesis plate 52, and the side of this osteosynthesis plate has and is formed at multiple serration 54 therein, these sawtooth Shape projection faces out from elongation sleeve 36 (and the center by this support lugn 14).Can most preferably see in Figure 5, sawtooth Each in shape projection 54 along towards support lugn 14 direction (i.e. along the direction of the distal end 56 away from leg 16) to Upper angled.When being implanted in bone tissue, such serration 54 angled up is to resist no bar humerus portion The mode engagement bone tissue of the pull-out of part 10.Elongation flank 58 extends along the length of joint plate 52, therefore forms T-shaped leg 16 " trunk ", osteosynthesis plate 52 formed its " cross bar ".Specifically, flank 58 be fixed to the joint plate 52 of leg dorsal part (i.e. with The relative side of serration 54), and extend internally along the direction at the center towards support lugn 14.The longitudinal direction of flank 58 Axis and the longitudinal axis parallel of joint plate 52.Fig. 2 and 5 can see, each in leg 16 includes oblique distal end portion Portion 62, this distal end is used as leading-in end, is inserted into humeral surface (the i.e. surgery of the surgery preparation in patient in order to leg 16 Surface produced by excision humeral head) in get out or in the hole that in other words formed.

Can most preferably see in figures 2 and 4, the lower surface 18 of the no support lugn 14 of bar humeral component has and formed In multiple undercutting 70 therein.In exemplary embodiment as herein described, undercutting 70 positions radially around elongation sleeve 36 Become each other in about 90 °.Can see in figures 2 and 4, the radial position of each in the position of undercutting 70 and watch window 30 Unanimously.Specifically, undercutting 70 is formed in identical side wall 72, and the footpath of each the sidewall defining in watch window 30 is inside Surface (defines the surface of the watch window 30 near the no center of bar humeral component 10).Antelabium is taken in each undercutting 70 74 form, this antelabium extends radially inwardly in its corresponding watch window 30.In such arrangement, such as in further detail below Description, the locking pawl that the antelabium 74 of undercutting 70 is positioned to for implanted thing to insert instrument engages.

No bar humeral component 10 can be constructed by the biocompatibility metal of implant level, but also can use other materials.This The example of metalloid includes cobalt, and including cobalt alloy such as cochrome, titanium includes titanium alloy such as Ti6A14V alloy, and stainless Steel.This metalloid no bar humeral component 10 also can be coated with surface conditioning agent, such as hydroxyapatite, to strengthen bio-compatible Property.Additionally, no bar humeral component 10 joint natural bone surface, the lower surface 18 of such as support lugn 14, elongation sleeve 36 outer surface and the outer surface of leg 16, can texture in order to part is fixed to bone.Such surface is alternatively many What hole coated is used for persistently fixing with promotion bone growth.

No bar humeral component 10 and head piece 12 can be set to various different configurations, met from patient to trouble with providing Flexibility required for the different anatomy of person.For example, no bar humeral component 10 and head piece 12 can arrange various diameters with The needs of coupling given patient.It should be appreciated that head thickness changes with head diameter.

With reference now to Fig. 6-24, it illustrates one group of surgical instruments, these surgical instruments can be used for the outer of the humerus of patient Section's preparation and the implantation of subsequent no bar humeral component 10.In such apparatus first is the impact shown in Fig. 6 and 7 Shank 80.As described in more detail below, impact shank 80 can be fixed to surgery drift or no bar humeral component 10, in order to No bar humeral component 10 is implanted to the humeral surface (i.e. surface produced by surgical excision humeral head) that the surgery of patient prepares In.Impact shank 80 includes extending main body 82, the one end of this elongation main body has impact head 84, the other end has Attachment means 86.Sleeve 88 is positioned around the outer surface of the main body 82 of impact shank such as by overmolding, and Immovably it is connected to this outer surface.Sleeve 88 is used as holder, and it is used for the surgery hand in implantation no bar humeral component 10 Surgeon is allowed to keep impact shank 80 during art.

The impact head 84 of impact shank 80 includes circular metal plate 90, and this metallic plate has the extraction flange extending from it 92.In use, surgeon keeps impact shank 80 via holder 88, and using surgery mallet, sledgehammer or other punchings Hit instrument to impact metallic plate 90, surgery drift 240 (referring to Figure 14) or no bar humeral component 10 are driven into the outer of patient In the humeral surface that section prepares.

The attachment means 86 of impact shank 80 include the lever 94 being pivotally coupled to the main body 82 impacting shank.Lever 94 include latch arms 96 and actuator arm 98, and this actuator arm is extended from the one end of latch arms 96 with an angle.Locking pawl 102 is fixed Position extends downwardly at the opposed end of latch arms 96 and from this opposed end.Locking pawl 102 is configured to engage herein The antelabium being formed in one of described surgical instruments (such as surgery drift or implant insert instrument) or similar structures, by this Class apparatus is selectively secured to impact shank 80.Connecting pin 104 is formed in the distal end of main body 82 of impact shank.Even Pin 104 stretches out from ring surface 106, and have with multiple surgical instruments as herein described (for example surgery drift or Implant insert instrument) in limit the shape substantially coupling of corresponding opening cross section.As shown in fig. 6, connecting pin 104 Cross section be generally D-shaped, therefore include plane 108.

The latch arms 96 of lever 94 extend beyond ring surface 106 so that locking pawl 102 is positioned above connecting pin 104 And extend towards its plane 108.This arrangement allows locking pawl 102 to be configured to engage multiple surgical instruments as herein described The antelabium being formed in (such as surgery drift or implant insert instrument) or similar structures, such apparatus is optionally fixed To impact shank 80.

As shown in fig. 7, the biasing element of such as spring 110 is connected to lever 94.Spring 110 is by the locking pawl of lever 102 bias towards the plane 108 of connecting pin 104.Do so, the biasing of spring 110 by locking pawl 102 and thus will impact handle Portion 80 locks onto multiple surgical instruments as herein described (such as surgery drift or implant insertion instrument).When surgeon or its When its user is downwardly against on the actuator arm 98 of lever, it is overcome by the biasing that spring 110 applies, so that lever 94 pivot Turn.When lever 94 pivots, locking pawl 102 moves along the direction of the plane 108 away from connecting pin 104.So, impact handle Portion 80 can discharge from coupled surgical instruments.

The metal parts (for example impacting the main body 82 of shank) of impact shank 80 can be constructed by medical grade metal, such as stainless Steel, cochrome or titanium, but other metal or alloy can be used.Additionally, in certain embodiments, it is possible to use such as polyethers ether The rigid polymer of copper (PEEK) etc.Holder 88 can be by polymer architecture such as silicones.

With reference now to Fig. 8 and 9, it illustrates be aligned shank 120.As described in more detail below, will no bar humerus Part 10 is implanted to the operation in the humeral surface (i.e. surface produced by surgical excision humeral head) of surgery preparation of patient Period, be aligned shank 120 can be fixed to sizing apparatus or cutting guiding piece.Be aligned shank 120 includes extending main body 122, and this is stretched Long main body has attachment means 126 in its distal end.Sleeve 128 is such as by overmolding around impact shank Main body 122 outer surface positioning, and be immovably connected to this outer surface.Sleeve 128 be used as holder, for Surgeon is allowed to keep be aligned shank 120 during the implantation no surgical operation of bar humeral component 10.

The attachment means 126 of be aligned shank 120 are similar to the attachment means 86 of impact shank 80, and therefore include and impact The lever 134 that the main body 122 of shank is pivotally coupled.Lever 134 includes latch arms 136 and actuator arm 138, and this actuator arm is with one Angle extends from the one end of latch arms 136.Locking pawl 142 is positioned at the opposed end of latch arms 136 and from this phase End is extended downwardly.Locking pawl 142 is configured to be bonded on the antelabium formed in sizing apparatus 160 or similar structures (referring to Figure 10), sizing apparatus 160 is regularly directed at shank 120.Key pin 144 is formed at the main body 122 of be aligned shank In distal end.Key pin 144 stretches out from ring surface 146, and has and the corresponding keyhole limiting in sizing apparatus 160 The cross section (referring to Figure 10) of the shape substantial match of opening 184.As shown in figure 8, the cross section of key pin 144 is key-shaped, and because This includes the circular portion with the rectangle part being fixed to the upper.

The latch arms 136 of lever 134 extend beyond ring surface 146 so that locking pawl 142 is positioned above key pin 144 And extend towards its upper surface.This arrangement allows locking pawl 142 to engage the antelabium being formed in sizing apparatus 160 or similar knot Structure (referring to Figure 10), sizing apparatus 160 is regularly directed at shank 120.

As shown in fig. 7, the biasing element of such as spring 150 is connected to lever 134.Spring 150 is by the locking pawl of lever 142 bias towards the upper surface of key pin 144.Do so, locking pawl 142 is locked onto sizing apparatus 160 by the biasing of spring 150, And thus be aligned shank 120 is locked onto sizing apparatus 160.When surgeon or other user are downwardly against the actuating of lever When on arm 138, it is overcome by the biasing that spring 150 applies, so that lever 134 pivots.When lever 134 pivots, locking Ratchet 142 moves along the direction of the upper surface away from key pin 144.So, be aligned shank 120 can discharge from sizing apparatus 160.

The metal parts (being for example directed at the main body 122 of shank) of be aligned shank 120 can be constructed by medical grade metal, such as not Rust steel, cochrome or titanium, but other metal or alloy can be used.Additionally, in certain embodiments, it is possible to use such as polyethers The rigid polymer of ether copper (PEEK) etc.Holder 128 can be by polymer architecture such as silicones.

With reference now to Figure 10 and 11, it illustrates sizing apparatus 160.As described in more detail below, sizing apparatus 160 The humeral surface that the surgery of patient prepares can be fixed to during the implantation no surgical operation of bar humeral component 10, for use as sizing Test and drift and brill guide.

Sizing apparatus 160 includes generally dome-shaped main body 162, and this main body has the upper surface 164 flattening and substantially flat Smooth lower surface 166.Elongation bore hole 168 extends through the center of sizing apparatus 160, and surface 164 extends to its following table from it Face 166.As described in more detail below, elongation bore hole 168 is used as to bore guide, to be used for the upper arm preparing in the surgery of patient Hole in bone surface, to receive the elongation sleeve 36 (referring to Fig. 2 and 5) of no bar humeral component 10.

Sizing apparatus 160 also includes the drift guide hole 170 of multiple general triangular.In fig. 10 it can be seen that drift Each in guide hole 170 is located in one of four quadrants of round flange 172 of sizing apparatus.So, drift guide hole Each in 170 is positioned to each other in about 90 °.Can see in figures 2 and 4, the position of drift guide hole 170 and no the bar upper arm The position consistency of the leg 16 of osteogenic section 10.So, hole 170 is used as drift guide, for prepare in the surgery of patient Punching in humeral surface, thus receive the leg 16 (referring to Figure 29) of no bar humeral component 10.For this reason, drift guide hole 170 The position also position consistency of each (referring to Figure 14) with the pointed tooth 252 of surgery drift 240.So, each of pointed tooth 252 can be with One of drift guide hole 170 drift guide hole is aligned, and passes through the propulsion of this drift guide hole.In this manner, sizing Part 160 prepares the humeral surface of patient to guide surgeon to make when receiving the no leg 16 of bar humeral component 10 in surgery With surgery drift 240 (referring to Figure 29).

Can see in fig. 11, sizing apparatus 160 has the multiple spikes 174 extending downwardly from its lower surface 166.Long Each in nail 174 has slightly pointed distal end 176.The surgery that spike 174 was pressed or was in other words driven into patient prepares The bone tissue of humeral surface (i.e. surface produced by surgical excision humeral head) in, by sizing apparatus 160 its use Period is secured in place.Multiple pin-and-holes 178 are also formed in the main body 162 of sizing apparatus, near its neighboring.Work as surgery When doctor's expectation supplements the attachment function of spike 174, surgery pin (not shown) is insertable through pin-and-hole 178, by sizing apparatus The bone group of 160 humeral surfaces (i.e. surface produced by surgical excision humeral head) being prepared with the surgery that pin is fixed to patient Knit.

Similar to no bar humeral component 10, also have in the flange 172 of sizing apparatus and be formed at multiple observation window therein Mouth 180.(i.e. surgical excision humeral head is produced the humeral surface that watch window 180 permission surgeon's observation surgery prepares Surface), so that it is guaranteed that sizing apparatus 160 complete seating during it is used for surgical operation.

In fig. 10 it can be seen that sizing apparatus 160 has connector 182, this connector can be by being directed at shank 120 Attachment means 126 are engaged, and sizing apparatus 160 is fixed to be aligned shank 120.Connector 182 has and is formed at wherein Key hole shaped opening 184.The distal end portion being sized and shaped to the main body 122 in be aligned shank for the reception of keyhole opening 184 The key pin 144 being formed in portion.Connector 182 also has and is formed at passage 186 therein.Connector 182 has along passage 186 Length formed undercutting 188.The forms that antelabium 190 is taken in undercutting 188, this antelabium be positioned at the top of passage 186 and Extend outwardly in passage 186.The locking pawl 142 (referring to Fig. 8 and 9) that antelabium 190 is aligned the attachment means 126 of shank connects Close, sizing apparatus 160 is fixed to be aligned shank 120.

In fig. 10 it can be seen that connector 182 is limited in the domed tendency of sizing apparatus.As more fully below Ground description, such arrangement allows test humeral head to be arranged on sizing apparatus, without interfering with connector 182.

It is similar to other apparatuses as herein described and implant, sizing apparatus 160 can be configured to there is multiple different chis Very little.For example, in exemplary embodiment as herein described, sizing apparatus 160 can be presented as there is different diameters, to simulate no The various possible diameter of bar humeral component 10.

Sizing apparatus 160 can be constructed by medical grade metal, such as stainless steel, cochrome or titanium, but can be using other gold Belong to or alloy.Additionally, in certain embodiments, it is possible to use the rigid polymer of such as polyethers ether copper (PEEK) etc.Polymerization Thing can be equally injection.

With reference now to Figure 12 and 13, it illustrates test head part 210.Test head part 210 is in the implantation no bar upper arm It is used for cooperation assessment during the surgical operation of osteogenic section 10 and humeral head part 12.Generally, test head part 210 is used for Guarantee the just size choosing of final humeral head part 12 (being finally implanted to the humeral head part 12 in the humerus of patient) Select.As described in more detail below, test head part also serves as brill guide, and this brill guide is used for guiding drill bit, should Drill bit is used for holing (or prebored hole) in the humeral surface that the surgery of patient prepares, to receive the leg of no bar humeral component 10 16 (referring to Figure 31 and 32).

In exemplary embodiment as herein described, test head part 210 is presented as Polymer Trials apparatus.So, Test head part 210 can be made up of any suitable medical grade polymer material.The example of such polymeric material includes Polyethylene, such as polyether-ether-ketone (PEEK) or acetal.In other embodiments, test head part can be formed by metal.

As the test apparatus for humeral head part 12, test head part 210 includes substantially hemisphere body 212.In figure 12 it can be seen that the main body 212 of test head part includes smooth rounded outer surface 214, this outer surface from Ring edge 216 dissipates, and this ring edge defines the great circle of the substantially hemispherical shape of main body.In figure 12 it can be seen that The main body 212 of test head part is hollow.The center of the spill downside surface 220 from main body for the center lug 218 is downward Extend.Center lug 218 has the multiple endless belts 222 being formed in its outer surface 224.As described in more detail below , by center lug 218 is inserted into the elongation bore hole 168 of sizing apparatus or the taper bore 40 of no bar humeral component In, test head part 210 may be installed sizing apparatus 160 or no in bar humeral component 10.The endless belt 222 of center lug Frictionally engage the taper bore 40 of no bar humeral component, so that center lug is frictionally fixed to no bar humeral component 10, and thus test head part 210 is frictionally fixed to no bar humeral component 10.

In figure 12 it can be seen that the main body 212 of test head part also has multiple cylinder protuberances 226, these The center of the spill downside surface 220 from main body for the cylindrical protuberance extends downwardly.Each protuberance 226 has embedded injection Or the in other words cylindrical metal sleeve 228 that is positioned in.Sleeve 228 have be formed at therein elongation bore hole 230, this Class bore hole 230 extends through the whole length of sleeve 228.Bore hole 230 is used as to bore guide, for guiding drill bit, this drill bit It is used for holing (or prebored hole) on the humeral surface that the surgery of patient prepares, to receive the leg 16 of no bar humeral component 10 (referring to Figure 31 and 32).So, when test head part 210 is fixed to sizing apparatus 160, the position of each guiding bore hole 230 Put the position consistency with the drift guide hole 170 of sizing apparatus 160, and each guiding bore hole 230 receives in the guiding of this drift In hole 170 (referring to Figure 28).Specifically, when test head part 210 is seated on sizing apparatus 160 completely, in test head The distal end of each protuberance 226 being formed in portion's part 210 is received the corresponding drift guide hole of sizing apparatus 160 In 170, thus guiding bore hole 230 is aligned in correct position.

Similar to other apparatuses and implant as herein described, test head part 210 can be configured to have multiple not Same size.For example, in exemplary embodiment as herein described, test head part 210 can be presented as have different straight Footpath (such as 15mm, 18mm or 21mm), with the diameter of the humeral head part 12 of analog selection.

With reference now to Figure 14, it illustrates surgery drift 240, for rushing in the humeral surface that the surgery of patient prepares Hole, to receive the leg 16 (referring to Figure 29 and 30) of no bar humeral component 10.Similar to other apparatus as herein described, surgery rushes 240 can be constructed by medical grade metal, such as stainless steel, cochrome or titanium, but can use other metal or alloy.Additionally, In certain embodiments, it is possible to use the rigid polymer of such as polyethers ether copper (PEEK) etc.

Surgery drift 240 is substantially fork-shaped, and includes metal master 242, and this metal master includes attached shaft 244. The proximal end of attached shaft 244 has and is formed at D-shaped pod 260 therein.The size of D-shaped pod 260, shape and position set Become to receive the D-shaped connecting pin 104 (referring to Fig. 6) of the attachment means 86 of impact shank 80.The outer surface of attached shaft 244 has and is formed In passage 246 therein.The side wall that the formation of axle 244 has passage 246 defines the undercutting that the length along passage 246 extends 248.The form of antelabium 250 is taken in undercutting 248, and this antelabium is positioned at the top of passage 246.Connecting pin when impact shank 104 when being inserted in the D-shaped pod 260 of surgery drift 240 and advancing downwardly afterwards, and antelabium 250 is by the attachment of impact shank The locking pawl 102 (referring to Fig. 6 and 7) of mechanism 86 is engaged, and surgery drift 240 is fixed to impact shank 80.

In axle 244 end relative with passage 246, the main body 242 of surgery drift includes multiple pointed tooths 252.Pointed tooth Each in 252 is fixed to axle 244 by pillar 268.Pointed tooth 252 is used for rushing in the humeral surface that the surgery of patient prepares Hole, to receive the leg 16 (referring to Figure 29 and 30) of no bar humeral component 10, is thus existed with the leg 16 of no bar humeral component 10 Corresponding on shape, size and position.Similar to the leg 16 of no bar humeral component 10, when from bottom front view (i.e. and pointed tooth The view of 252 longitudinal axis orthogonal) when observing, the pointed tooth 252 of each surgery drift is generally T-shaped.In such arrangement, Each in pointed tooth 252 has bomeplasty plate 254 and elongation flank 256.Elongation flank 256 prolongs along the length of joint plate 254 Stretch, therefore form " trunk " of T-shaped pointed tooth 252, wherein joint plate 254 forms " cross bar " of T-shaped pointed tooth 252.Specifically, engage The outer surface of plate 254 faces out from the other pointed tooths longitudinal axis of surgery drift (and therefore), and wherein flank 256 is fixed to point The dorsal part of joint plate 254 of tooth simultaneously extends internally along towards the direction of other pointed tooths 252.The longitudinal axis of flank 256 and joint The longitudinal axis parallel of plate 254.Can see in fig. 14, each pointed tooth 252 includes the oblique distally as pilot punch surface End 258.Tiltedly distal end 258 also serves as introducing end surfaces, the humerus that the surgery being inserted into patient in order to pointed tooth 252 prepares In the hole getting out in advance on surface.

The position consistency of the drift guide hole 170 of the position of pointed tooth 252 and sizing apparatus 160.So, drift guide hole 170 are used for guiding the propulsion of pointed tooth 252, punching in the humeral surface being prepared with the surgery in patient, thus receiving no bar humerus The leg 16 (referring to Figure 29 and 30) of part 10.So, each pointed tooth 252 can be aligned with drift guide hole 170 and pass through this punching Head guide hole propulsion.

The main body 242 of surgery drift also includes center spike 262, and this center spike extends downwardly into pointed tooth 252 from axle 244 Between region in.Center spike 262 is centrally located on the longitudinal axis of surgery drift 240.Center spike 262 includes point Distal end 264.Using surgery drift 240 punching with receive no bar humeral component 10 leg 16 during, center spike 262 End 264 patient surgery prepare humeral surface in formed generating layer (divot).Such generating layer is positioned to receive no bar The elongation sleeve 36 of humeral component 10.

With reference now to Figure 15 and 16, it illustrates center bit 270 and Periphery bit 272.Center bit 270 is used for suffering from The humeral surface Chinese and foreign department boring that the surgery of person prepares, to receive the elongation sleeve 36 of no bar humeral component 10.On the other hand, week Side drill bit 272 is used for holing (or prebored hole) on the humeral surface that the surgery of patient prepares, to receive no bar humeral component 10 Leg 16 (referring to Figure 31 and 32).Each in drill bit 270,272 includes the elongation handle of a knife 274 with proximal end 276, should Elongation handle of a knife is coupled in the chuck of rotary power tool (not shown) or is coupled in manual shank (not shown).Drill bit 270th, 272 also include cutting head 278, and this cutting head is located at the relative distal end of handle of a knife 274.Drill bit 270,272 Cutting head 278 include sharp incision tip 280, multiple spirality cutting grooves 282 from this incision tip extend.

Each upper end being additionally included in cutting groove 282 in drill bit 270,272 is positioned at cutting head 278 top Annular lining ring 284.Lining ring 284 is used as depth stop part, to guarantee that drill bit 270,272 gets out each of which in desired depth Hole.For center bit 270, the external diameter of lining ring is more than the diameter of the elongation bore hole 168 of sizing apparatus 160.Thus, center Drill bit 270 can be advanced in bone tissue, until the lower surface 286 of lining ring 284 is preferably minimized or in other words engages sizing apparatus 160 upper surface 164 flattening.Equally, Periphery bit 272 can be advanced in bone tissue, until the lower surface 286 of lining ring 284 It is preferably minimized or the in other words edge in the sleeve 228 of conjugation test head piece 210 or shelf.

Drill bit 270,272 can be made up of medical grade metal, such as stainless steel, cochrome or titanium, although equally can use Other metal or alloy.Additionally, in certain embodiments, it is possible to use the rigid polymer of such as polyethers ether copper (PEEK) etc Thing.

With reference now to Figure 17-19, show head resection guide 290.Head resection guide 290 is used as cutting guiding Part, to guide bone saw blade to advance thus excising the humeral head of patient.Head resection guide 290 includes base portion 292, this base Portion has a pair of guide rails 294 stretching out from base portion.The static cutting guiding piece 296 of arch be fixed to guide rail 296 with The relative end of base portion 292.Specifically, one end of static cutting guiding piece 296 is fixed to one of guide rail 294, static Cutting guiding piece 296 the other end be fixed to another guide rail 294.

Movable cutting guiding piece 298 is trapped on guide rail 294, and can move back and forth along guide rail 294.Specifically Ground, movable cutting guiding piece 298 includes guide body 302, and this guide body has and is formed at a pair of holes 304 therein.Draw One of guide rail 294 is positioned in a hole in hole 304, and another guide rail 294 is positioned in another hole 304.So, Movable cutting guiding piece 298 can be along guide rail 294 towards static cutting guiding piece 296 with away from static cutting guiding Move on the direction of part 296.

Biasing element, such as helical spring 306, are trapped in each in guide rail 294.Spring 306 is positioned at base portion Between 292 upper surface 308 and the movable lower surface 310 of main body 302 of cutting guiding piece.So, spring 306 is movable Apply spring biasing on cutting guiding piece 298, it is pushed along towards the direction of static cutting guiding piece 296.

The main body 302 of movable cutting guiding piece also has and is formed at finger clamp gripping member 312 therein.As herein described In exemplary embodiment, finger clamp gripping member 312 is presented as flange, and this flange is along outside with guide rail 294 direction generally perpendicular Extend.Surgeon or other user can hold the lower surface 314 of finger clamp gripping member 312 and base portion 292, afterwards jam-packed he Or her finger.Do so overcomes the spring biasing of spring 306, and along away from static cutting guiding piece 296 Direction (i.e. along the direction towards base portion 292) biases or in other words moves movable cutting guiding piece 298.Once surgeon Release finger clamp gripping member 312, the spring biasing of spring 306 is just along direction (the i.e. edge returning towards static cutting guiding piece 296 The direction away from base portion 292) bias or in other words move movable cutting guiding piece 298.

Can most preferably see in figure 18, static cutting guiding piece 296 and movable both cutting guiding pieces 298 wrap Include circular surface, these circular surfaces coordinate to limit the circular surface of the humeral head for capturing patient wherein.Specifically Ground, static cutting guiding piece 296 includes the of roughly semicircular rear surface 318 of rounding, and this rear surface is towards movable cutting The of roughly semicircular front surface 320 of the rounding of guiding piece 298.Figure 17 and 18 can see, multiple spike 322 is from semicircle Each in shape surface 318,320 stretches out towards relative semicircular surface 318,320.Spike 322 engages the humerus of patient Bone tissue so that during use by head resection guide 290 be maintained at desired position and orientation in.So, when outer During the lower surface 314 of section doctor jam-packed finger clamp gripping member 312 and base portion 292, semicircular surface 318,320 moves into remote each other From being consequently formed gap to position between them the humeral head of patient.Afterwards, when surgeon discharges finger clamp gripping member 312 and base portion 292 lower surface 314 when, semicircular surface 318,320 moves towards each other, and thus utilizes spike 322 by patient Humeral head capture between them.

Figure 17 and 18 can see, movable cutting guiding piece 298 has and is formed at multiple pin-and-hole 324 therein. The axis of each in pin-and-hole 324 extends along the direction tilting with respect to guide rail 294 and spike 322 or be at an angle of.As following It is more fully described, surgery pin is insertable through pin-and-hole 324, so that by head during the natural humeral head excision of patient Resection guide 290 is fixed to the humerus of patient by pin.

The side view of Figure 19 can most preferably be seen, static cuts guiding piece 296 and movable cutting guiding piece 298 include flat surfaces, and to limit cutting guidance surface, this cutting guidance surface is used for guiding bone saw blade flat surface engagement To excise the natural humeral head of patient.Specifically, described static cutting guiding piece 296 includes flat rear guidance surface 326, This flat rear guidance surface is aligned to become relation of plane altogether with the flat front guidance surface 328 of movable cutting guiding piece 298.Two Individual guidance surface 326,328 collectively defines cutting surfaces, in the cutting operation phase of the natural humeral head in order to excise patient Between, bone saw blade can support (guiding) on this cutting surfaces.Figure 19 can see, two guidance surfaces 326,328 It is in guide rail 294 general parallel orientation and in the plane vertical with the lower surface 314 of finger clamp gripping member 312 and base portion 292.

Head resection guide 290 can be made up of medical grade metal, such as stainless steel, cochrome or titanium, although equally Can be using other metal or alloy.Additionally, in certain embodiments, it is possible to use the rigidity of such as polyethers ether copper (PEEK) etc Polymer.

With reference now to Figure 20-23, show implant insertion instrument 330.Implant insertion instrument 330 can be fixed to no bar Humeral component 10, in the humeral surface that the surgery being implanted to patient in order to no bar humeral component 10 prepares.Implant inserts work Tool 330 includes extending main body 332, and this elongation main body defines the cylindrical shaft 334 in proximal end with connector 336. Connector 336 includes the D-shaped pod 338 being formed in its proximal end.The size of D-shaped pod 338, shape and position are set to Receive the D-shaped connecting pin 104 (referring to Fig. 6) of the attachment means 86 of impact shank 80.The outer surface of the connector 336 of main body has It is formed at passage 340 therein.The side wall that the formation of connector 336 has passage 340 defines that the length along passage 340 extends Undercutting 342.The form of antelabium 344 is taken in undercutting 342, and this antelabium is positioned at the top of passage 340.Company when impact shank When pin 104 is inserted in the D-shaped pod 338 of implant insertion instrument 330 and advances downwardly afterwards, antelabium 344 is impacted The locking pawl 102 (referring to Fig. 6 and 7) of the attachment means 86 of shank engages, and implant is inserted instrument 330 and is fixed to impact Shank 80.

The relative end of connected device 336 that implant inserts the main body 332 of instrument has and is formed at be aligned therein Flange 346.Directed flange 346 is presented as ring surface, and this ring surface has the multiple projections extending downwardly from it or alignment keys 348.The size of alignment keys 348, shape and position are set to and are received the watch window being formed in no bar humeral component 10 In 30.Directed flange 346 also has the alignment pin 350 extending downwardly from its annular surface.The size of alignment pin 350, shape and Position is set to and is received in the taper bore 40 being formed in no bar humeral component 10.

Figure 20 and 21 can see, a pair of locking arm 352 is pivotally coupled to the main body 332 of insertion instrument.Often Individual lock arm 352 has the cam follower 354 being formed in its proximal end, and is formed in its relative distal end Generally L-shaped locking pawl 356.Each lock arm 352 can pivot by pivotal pin 358 at the position of its ring surface 346 close It is connected to the main body 332 that implant inserts instrument with turning, this pivotal pin is positioned in the hole 360 being formed in main body 332.Locking Arm 352 pivots around pivotal pin 358 so that cam follower 354 is along towards each other and thus towards the axle of the main body 332 of insertion instrument The motion in 334 direction causes locking pawl 356 along the alignment pin of the main body 332 away from each other and thus away from insertion instrument The motion in 350 direction.On the other hand, cam follower 354 is along the main body 332 away from each other and thus away from insertion instrument The direction of axle 334 motion cause locking pawl 356 along towards each other and thus towards insertion instrument main body 332 be aligned The motion in the direction of pin 350.

This motion of lock arm 352 can be used as the part that " quick connect " arranges, with optionally will no bar humerus Part 10 and implant insert instrument 330 and lock and discharge.Specifically, when directed flange 346 and the no bar humerus of insertion instrument Part 10 is coupled so that its alignment pin 350 and alignment keys 348 are respectively positioned at the taper bore 40 of no bar humeral component and see When examining in window 30, the locking pawl 356 of lock arm 352 is positioned at the remaining watch window 30 of no bar humeral component (i.e. not It is aligned the watch window 30 that key 348 occupies) in.In the case of being positioned such that, locking pawl 356 be moveable to from formation And therefrom move in the joint of the antelabium 74 of the undercutting 70 in the lower surface 18 of the support lugn 14 of no bar humeral component Go out (referring to Fig. 2 and 4).Specifically, locking pawl 356 can be along towards each other (i.e. towards the alignment pin of the main body 332 of insertion instrument 350) direction motion is so that locking pawl 356 engages the lower surface 18 of the support lugn 14 being formed at no bar humeral component In undercutting 70 antelabium 74, thus by no bar humeral component 10 be fixed to implant insertion instrument 330.Relatively, lock spine Pawl 356 can be along the direction motion of (i.e. away from the alignment pin 350 of the main body 332 of insertion instrument) away from each other so that locking spine Pawl 356 departs from the antelabium 74 of the undercutting 70 in the lower surface 18 of support lugn 14 being formed at no bar humeral component, thus will No bar humeral component 10 is inserted instrument 330 from implant and is discharged.

Figure 20 and 21 can see, spin locking lining ring 362 is trapped in the axle 334 of the main body 332 of insertion instrument On.Specifically, locking lining ring 362 has the bore hole 364 of through its center extension, and the axle 334 of the main body 332 of insertion instrument receives (positioning) is in this bore hole 364.So, locking lining ring 362 can be around the axle 334 of the main body 332 of insertion instrument along side clockwise To and counterclockwise rotates.Can most preferably see in fig. 20, locking lining ring 362 have on the downside of it be formed at therein A pair of channels 366.When locking lining ring 362 rotates around axle 334, the cam follower 354 of lock arm 352 is gone in passage 366 Enter.The side wall limiting the inner side of passage 366 limits cam face 368.Can see in fig. 20, one end of cam face 368 Portion 370 than cam face 368 the other end 372 closer to locking lining ring bore hole 364 (and thus closer to insertion instrument The axle 334 of main body 332).So, when each cam follower 354 along its corresponding cam face 368 from its inner end 370 to the side of its outer end 372 travel upwardly when, cam follower 354 is along away from each other and thus away from insertion instrument The axle 334 of main body 332 direction motion, thus cause lock arm 352 to pivot so that locking pawl 356 along towards each other and by The direction motion of the alignment pin 350 of this main body 332 towards insertion instrument.As described above, this motion of locking pawl 356 is used for No bar humeral component 10 is locked onto implant insertion instrument 330.Can see in fig. 20, as herein described exemplary In embodiment, turning clockwise of lining ring 362 of locking causes cam follower 354 along cam face 368 in such direction Upper (i.e. on the inner end 370 of cam face to the direction of its outer end 372) motion.

Relatively, when each cam follower 354 along corresponding cam face 368 in its outer end 372 is to it When the side of end 370 travels upwardly, cam follower 354 is along towards each other and thus towards the axle 334 of the main body 332 of insertion instrument Direction motion, thus cause lock arm 352 to pivot so that locking pawl 356 along away from each other and thus away from insertion work The direction motion of the alignment pin 350 of main body 332 of tool.As described above, this motion of locking pawl 356 be used for will no bar humerus Part 10 inserts instrument 330 from implant and discharges.Can see in fig. 20, in exemplary embodiment as herein described, lock The rotate counterclockwise determining lining ring 362 causes cam follower 354 along cam face 368 in a direction such (i.e. from convex The outer end 372 of wheel surface is on the direction of its inner end 370) motion.

Figure 20 and 21 can see, locking lining ring 362 has a pair of the pilot pin 374 running through extension.Outside pilot pin 374 End is positioned adjacent to the outer surface of locking lining ring 362, and its inner end (not shown) is positioned in the (not shown) of circular passage, should Circular passage is formed on the outer surface of axle 334 of the main body 332 of insertion instrument.During locking lining ring 362 rotation, pilot pin 374 inner end is advanced in such passage.The axle 334 of the main body 332 of insertion instrument also has in its outer surface and is formed at A pair of beeline channel 376 therein.Beeline channel 376 be arranged to parallel to each other, and with insertion instrument main body 332 axle 334 longitudinal axis parallel.When the inner end of pilot pin 374 is aligned and receives in beeline channel 376, locking lining ring 362 can With the axle 334 of the main body 332 along insertion instrument in the square upward sliding towards connector 336 (i.e. away from directed flange 346).This Sample does, and each cam follower 352 of lock arm 350 is deviate from from the passage 366 of corresponding locking lining ring 362.Such cloth Put cleaning implant between use allows cam follower 352 and locking lining ring 362 passage during inserting instrument 330 366 are completely exposed to cleaning fluid.When the axle 334 of the main body 332 along insertion instrument for the locking lining ring 362 is away from connector During the square upward sliding of 336 (i.e. towards directed flange 346), cam follower 352 can be by the inner with passage 366 by them Portion 370 be aligned and slip back to its respective locking lining ring 362 passage 366 in.Afterwards, locking lining ring 362 can rotate, will Cam follower 352 captures in the passage 366 of its respective locking lining ring 362 again.

Each part (such as its main body 332, lock arm 352 and locking lining ring 362) that implant inserts instrument 330 can be by curing Constituted with level metal, such as stainless steel, cochrome or titanium, although equally can be using other metal or alloy.Additionally, at some In embodiment, it is possible to use the rigid polymer of such as polyethers ether copper (PEEK) etc.

With reference now to Figure 24, show head impact instrument 380.Head impact instrument 380 can be used to impact, thus by head Portion's part 12 conically locks onto no bar humeral component 10.Head impact instrument 380 includes generally conical main body 382, this master The proximal end of body has and is formed at connector 384 therein.Connector 384 includes circular open 386, the size of this opening, Shape and position are set to the connecting pin 104 (referring to Fig. 6) receiving the attachment means 86 impacting shank 80.Head impact instrument 380 connector 384 also has and is formed at three passages 388 therein.The formation of the main body 382 of head impact instrument has passage 388 side wall limits the undercutting 390 of the length extension along passage 388.The form of antelabium 392, this lip are taken in each undercutting 390 Edge is positioned at the top of corresponding passage 388.Antelabium 392 is optionally by the locking spine of the attachment means 86 of impact shank Pawl 102 engages (referring to Fig. 6 and 7), and head impact instrument 380 is fixed to impact shank 80.

The end relative with connector 384 of the main body 382 of head impact instrument has and is formed at the recessed of rounding therein Shape shock surface 396.The size on this concave impulse surface 396, shape and position are set to and conform closely with head piece 12 Convex, close substantially hemispheric outer surface.As being more fully described below with reference to Figure 35, when head piece 12 is installed During to no bar humeral component 10, head impact instrument 380 is first coupled to impact shank 80, is located so that head impact afterwards The shock surface 396 of instrument 380 is positioned to contact with the outer surface of head piece 12.Then, surgeon can using surgery rod, Hammer or other percussion tool hit the metal beater plate 90 impacting shank, head piece 12 is driven and is attached to taper locking No bar humeral component 10.It should be appreciated that head impact instrument 380 can be by polymer architecture, such as polyether-ether-ketone (PEEK), second contracting Aldehyde, PPSU or other polymer.

With reference now to Figure 25-36, show surgical operation, be wherein used for herein in conjunction with the various apparatuses described in Fig. 6-24 outer Section prepares the humerus 400 of patient, for implanting the no bar artificial body of the humerus 10 of Fig. 1-5.Surgical operation starts from operation consent plan, Wherein among other, CT scan (2D or 3D) or other types of preoperative imaging (such as X-ray) can be carried out, by terms of Draw the no placement location of bar humeral component 10 and humeral head part and orientation.If the operation planned is shoulder displacement hand Art, then CT scan or other types of preoperative imaging may also be used for planning the pass of the prosthese in the glenoid cavity of patient to be implanted The placement location of section broad-mouthed receptacle for holding liquid part (not shown) and orientation.After preoperative plan terminates, dissect and shrink the soft tissue of patient, with Allow to touch shoulder joint.Generally, (i.e. 360 °) the completely exposures of humeral head 402 of patient.

Once the humeral head 402 of patient exposes on surgery ground, then surgeon can start the process excised. As shown in figure 25, surgeon first head resection guide 290 is arranged on the humerus 400 of patient.Do so, surgery is cured The lower surface 314 of the base portion 292 of raw holding finger holder 312 and head resection guide, jam-packed is his or her afterwards Finger.Do so overcomes the spring biasing of spring 306, and along direction (the i.e. edge away from static cutting guiding piece 296 The direction towards base portion 292) biasing or in other words move movable cutting guiding piece 298, it is consequently formed gap with by patient Humeral head 402 be positioned between the semicircular surface 318,320 of each of which.

Then, head resection guide 290 is positioned so that static around the humeral head 402 of patient by surgeon Cutting guiding piece 296 is resisted against in the rear muscle group insertion site of rotation muscle group of patient.Do so is protected during head excision Rotate muscle group afterwards, and be step guiding piece 296 being placed at correct height and pattern.Then, surgeon will be movable Cutting guiding piece 298 front surface 320 be located against the humerus 400 of patient at desired excision angle and height before Surface 404.Surgeon by cut guiding piece 298 be positioned on the humeral head 402 of patient so that front guidance surface 328 with The joint margins be aligned of humeral head 402.Then, surgeon discharges the lower surface 314 of finger clamp gripping member 312 and base portion 292. Do so, the corresponding semicircular surface 318,320 of movable cutting guiding piece 298 and static cutting guiding piece 296 is towards that This motion, is thus captured the humeral head 402 of patient between semicircular surface using spike 322.

Once surgeon by movable cutting guiding piece 298 be placed on desired excision angle and highly in, that Surgery pin 406 can be inserted through each pin-and-hole 324 by surgeon, and head resection guide 290 is fixed by pin To the humerus 400 of patient, thus the front guidance surface 328 of movable cutting guiding piece 298 is maintained in its desired position, As shown in figure 25.

As shown in figure 26, then surgeon operates bone saw, such as shakes power saw 408, to excise the head of humerus of patient Portion 402.Do so, surgeon by the saw blade 410 of power saw 408 be positioned at movable cutting guiding piece 298 flat before On guidance surface 328.Then, surgeon activates concussion power saw 408 and applies pressure thereon so that it is advanced to backward Contact with the front surface 404 of the humerus 400 of patient.Contact with the front surface 404 of humerus 400 when saw blade 410 is advanced into backward And afterwards along the direction towards surface 412 thereafter pass through part when, the concussion campaign grinding humeral head of bone saw 408 402 bone tissue.

Surgeon makes power saw 408 continue to advance backward, until saw blade 410 leaves bone.Specifically, surgeon Continue operation bone saw 408, until the distally pointed tooth of its blade 410 exceeds the rear surface 412 of humeral head 402.After bone In the case that surface 412 is left, saw blade 410 is supported and is guided by the rear guidance surface 326 of static cutting guiding piece 296. So, the rear rotation muscle group that the rear guidance surface 326 of static cutting guiding piece 296 prevents saw blade 410 from contacting patient.Once Saw blade 410 has been moved off bone and is advanced in the static rear guidance surface 326 of cutting guiding piece 296, and surgeon can Disable bone saw 408, lift off the cut-out of the humeral head 402 of patient afterwards.Can see in fig. 26, humerus 400 Surgical excision surface 414 be substantially flat.

As shown in figure 27, surgeon now determines that the no bar humeral component 10 of suitable dimension, to be implanted in humerus 400 On the surface 414 of surgical excision.Do so, surgeon uses sizing apparatus 160.Specifically, as described in more detail below , sizing apparatus 160 can be fixed to the surface 414 of the surgical excision of humerus 400 of patient, for use as sizing test and drift With brill guide.Do so, surgeon's initial selected one estimates the different chi of just size for patient from surgeon Very little sizing apparatus 160.Then, selected sizing apparatus 160 is connected to be aligned shank 120 by surgeon.Specifically, outward Section doctor makes the key pin 144 being formed in the distal end of the main body 122 of be aligned shank advance and be inserted in sizing apparatus 160 In the key hole shaped opening 184 of middle formation, until the antelabium 190 of the connector 182 of sizing apparatus is aligned the attachment means of shank 126 locking pawl 142 (referring to Fig. 8 and 9) engages, and thus sizing apparatus 160 is fixed to be aligned shank 120.Then, surgery Selected sizing apparatus 160 is placed on the surface 414 of surgical excision of humerus 400 doctor, and assesses level of coverage. If surgeon determines that selected sizing apparatus 160 is not correct size, then initial sizing apparatus 160 is moved Remove, and there is the sizing apparatus 160 of different-diameter and be attached to be aligned shank 120 and be estimated.

Once correct diameter sizing apparatus 160 it has been determined that sizing apparatus 160 is just fixed to humerus by surgeon The surface 414 of 400 surgical excision.Do so, surgeon utilize be aligned shank 120 by sizing apparatus 160 be positioned at for In the desired position and orientation of final implant (i.e. no bar humeral component 10), the spike 174 of wherein sizing apparatus 160 is downward Surface 414 towards the surgical excision of humerus 400.Then, sizing apparatus 160 is pressed down on or in other words pushes away by surgeon In the cancellous bone on surface 414 of the surgical excision being pressed onto humerus 400, thus it is fixed in position, as shown in figure 27.Outward Section doctor can observe the surface 414 of the surgical excision of humerus 400 using the watch window 180 of sizing apparatus, to guarantee sizing The complete seating of apparatus 160 is thereon.

Once on the surface 414 of the surgical excision already installed on humerus 400 for the sizing apparatus 160, surgeon can hold The compatibility test in advance of the final humeral head part 12 of row.Do so, surgeon's initial selected one is estimated with surgeon For the just size various sizes of test head part 210 of patient, afterwards selected test head part 210 is installed To sizing apparatus 160 (referring to Figure 28).By wherein stretching of sizing apparatus will be inserted into by heart lug 218 (referring to Figure 12 and 13) Press down in long boring 168 and afterwards by test head part 210 or in other words push until its be seated in completely fixed On footpath apparatus 160, test head part 210 is arranged on sizing apparatus 160 surgeon.

Test head part 210 is used for guaranteeing that final humeral head part 12 (is finally implanted in the humerus of patient Humeral head part 12) just size select.So, once test head part 210 is arranged on sizing apparatus 160, outward Section doctor just can visually assess its size and cooperation, to obtain final implant (i.e. no bar humeral component 10 and the head of humerus Portion's part 12) size and cooperation sensing.If surgeon is unsatisfied with assessed size and cooperation, then replaceable examination Test one of head piece 210 and sizing apparatus 160 or both.If the assessed size of surgeon's satisfaction and cooperation, So test head part 210 removes from sizing apparatus 160, subsequently the bone of the humeral surface 414 of surgical excision of execution patient Preparation.

As shown in figure 29, then, surgeon can utilize the humeral surface of the surgical excision in patient for the surgery drift 240 Punching in 414, to receive leg 16 and the elongation sleeve 36 of no bar humeral component 10.It should be appreciated that surgeon can utilize many Individual alignment pin (not shown), these alignment pins are inserted through pin-and-hole 178, so that by sizing tool before using surgery drift 240 Tool 160 is fixed to the bone tissue of the humeral surface 414 of the surgical excision of patient.In order to execute punching press program, by D-shaped is connected Pin 104 is inserted in the D-shaped pod 260 being formed in the attached shaft 244 of surgery drift 240 until being formed in attached shaft 244 Antelabium 250 engaged by the locking pawl 102 (referring to Fig. 6 and 7) of the attachment means 86 of impact shank, by surgery drift 240 It is fixed to impact shank 80, surgery drift 240 is fixed to impact shank 80 by surgeon first.

Afterwards, surgeon using impact shank 80 mapping surgical drift 240 so that each of which pointed tooth 252 and sizing tool One drift guide hole 170 of tool 160 is aligned.Do so is also by the center spike 262 of surgery drift and stretching of sizing apparatus 160 Long boring 168 is aligned.So, drift guide hole 170 and elongation bore hole 168 are respectively intended to guide pointed tooth 252 and center spike 262 Propulsion.

Once surgery drift 240 is positioned in sizing apparatus 160 by this way, surgeon just utilizes surgery mallet Rod, sledgehammer or other percussion tools, to hit the metallic plate 90 of impact shank 80, surgery drift 240 are driven into patient's In the humeral surface 414 of surgical excision, until surgery drift drops on sizing apparatus 160.As shown in figure 30, do so is being suffered from Form multiple punchings 416, the shape of this some holes, size and position and no bar humerus in the humeral surface 414 of the surgical excision of person The leg 16 of part 12 is corresponding.Also as shown in figure 30, impact surgery drift 240 is also in the surgical excision of patient by this way Be formed as the recess of generating layer 418 form, the shape of this recess, size and position and no bar humeral component 10 in humeral surface 414 Elongation sleeve 36 corresponding.

Then, the humeral surface 414 of surgeon's surgical excision from patient by surgery drift 240 withdraws, outer to expose Hole 416 and generating layer 418 that section ground is formed, as shown in figure 30.If necessary, surgeon can striking impact shank extraction flange 92 downside, in order to this extraction of surgery drift 240.

With reference now to Figure 31 and 32, show the pre-adjustment program with regard to the punching press program described in Figure 29 and 30.In other words Say, drilling program wherein can be holed in advance as prebored hole program performing in the humeral surface 414 that the surgery of patient prepares, Then, such hole getting out in advance carries out punching press in the above described manner using surgery drift 240, to receive no bar humeral component 10 Leg 16.In order to execute such drilling program, surgeon is using the test head part being provided with sizing apparatus 160 210.In bone preparation (relative with testing), test head part 210 is used as to bore guide, and for guiding drill bit, this drill bit is used To hole (or prebored hole) in the humeral surface 414 that the surgery of patient prepares, to receive the leg 16 of no bar humeral component 10 With elongation sleeve 36.In order to start such drilling program, surgeon selects size and sizing apparatus 160 phase installed first The test head part 210 of selection is installed to sizing apparatus 160 (referring to Figure 31) by corresponding test head part 210 afterwards. By wherein heart lug 218 (referring to Figure 12 and 13) being inserted in the elongation bore hole 168 of sizing apparatus and will try afterwards Test head piece 210 and press down on or in other words push and be seated in completely on sizing apparatus 160 until it, surgeon will try Test head piece 210 to be arranged on sizing apparatus 160.

When test head part 210 is installed to sizing apparatus 160, every in the guiding bore hole 230 of test head part The position consistency of individual position and the drift guide hole 170 of sizing apparatus 160, and each guiding in bore hole 230 receive and exist In this drift guide hole 170.Specifically, when test head part 210 is seated on sizing apparatus 160 completely, in test head The distal end (referring to Figure 12 and 13) of each protuberance 226 being formed in portion's part 210 receives the correspondence of sizing apparatus 160 In drift guide hole 170, thus guiding bore hole 230 is aligned in correct position.

Then, the proximal end of Periphery bit 272 is inserted in the chuck of rotary power tool (not shown) or inserts To in manual shank (not shown).Then, the end 280 of the cutting head 278 of Periphery bit is inserted into test by surgeon In one guiding bore hole 230 of head piece 210, and activate this power drill bit (or rotating this manual shank).Surgeon The Periphery bit 272 is made to be advanced in the bone tissue of humeral surface 414 of the surgical excision of patient, until the lining ring 284 of drill bit Lower surface 286 is preferably minimized or the in other words edge in the sleeve 228 of conjugation test head piece 210 or shelf.Then, outward Drill bit 272 is removed from the guiding bore hole 230 corresponding with the periphery hole newly getting out by section doctor, and in remaining guiding boring Repeat this process in hole 230.Then, test head part 210 is removed by surgeon from sizing apparatus 160, to expose surgery The periphery hole 420 getting out, the leg 16 (referring to Figure 32) that the position of this periphery hole corresponds to no bar humeral component 10 will be implanted Place.

In the case that test head part 210 removes, the then humeral surface of the surgical excision in patient for the surgeon Hole in 414, to receive the elongation sleeve 36 of no bar humeral component 10.Do so, surgeon is by the nearside of center bit 270 End is fixed in the chuck of rotary power tool (not shown) or is fixed in manual shank (not shown).Then, surgery The end 280 of the cutting head 278 of center bit is inserted in the elongation bore hole 168 of sizing apparatus 160 and activates this by doctor Power drill (or rotating this manual shank).Surgeon makes center bit 270 be advanced to the humeral surface of the surgical excision of patient In 414 bone tissue, until the lower surface 286 of the lining ring 284 of drill bit is preferably minimized or in other words engages sizing apparatus 160 The upper surface 164 flattening.Then, drill bit 270 is removed by surgeon from the elongation bore hole 168 of sizing apparatus 160.

As shown in figure 32, then surgeon removes sizing apparatus 160, to expose the periphery hole 420 that surgery gets out, this week Lateral opening position is corresponding with the position of the leg 16 of no bar humeral component 10 that will be implanted, and includes what surgery got out Centre bore 422, the position of this centre bore is corresponding with the position of the elongation sleeve 36 of no bar humeral component 10 that will be implanted.

Once the humeral surface 414 of the surgical excision of patient has prepared, surgeon just can implant no bar humerus Part 10.Do so, as shown in figure 33, by being inserted into, by the D-shaped connecting pin 104 of shank, the connector that implant inserts instrument Until the antelabium 344 of connector passes through to impact the locking pawl 102 (ginseng of the attachment means 86 of shank in 336 D-shaped pod 338 See Fig. 6 and 7) engaged and impacted shank 80 to insert instrument 330 and to be fixed to implant, implant is inserted by surgeon first Enter instrument 330 and be fixed to impact shank 80.

Afterwards, the no bar humeral component 10 of suitable dimension (is had by the above-mentioned diameter testing selection by surgeon Part 10) be fixed to implant insertion instrument 330.Implant is inserted the locking lining ring 362 of instrument 330 by surgeon first Be positioned at unblock or off-position in, in this unblock or off-position, implant insert instrument lock arm 352 cam from Moving part 354 is positioned near the inner end 370 of cam face 368 of locking lining ring, is thus positioned at each other locking pawl 356 Away from maximum distance apart.Then, the directed flange 346 of the instrument of insertion is positioned to connect with no bar humeral component 10 by surgeon Close so that its alignment pin 350 and alignment keys 348 are respectively positioned at taper bore 40 and the watch window 30 of no bar humeral component In.The locking pawl 356 of the lock arm 352 of implant insertion instrument is positioned at the remaining sight of no bar humeral component by do so Examine in window 30 (not being aligned the watch window 30 that key 348 occupies).

Surgeon makes locking lining ring 362 turn clockwise, and locking lining ring 362 is moved to its lock from its unlocked position Positioning is put.This rotation of locking lining ring 362 causes implant to insert each cam follower 354 of the lock arm 352 of instrument Travelling upwardly along its corresponding cam face 368 from the side of its inner end 370 to its outer end 372.This is done so that convex Wheel driven member 354 moves along direction away from each other, thus causes lock arm 352 to pivot so that locking pawl 356 is along court Direction motion each other.This moving in the direction along towards each other of locking pawl 356 causes locking pawl 356 to be bonded on no The antelabium 74 of the undercutting 70 being formed in the lower surface 18 of the support lugn 14 of bar humeral component, thus will no bar humeral component 10 It is fixed to implant insertion instrument 330.

Afterwards, as shown in figure 33, surgeon positions no bar humeral component 10 so that its leg using impact shank 80 Each in 16 is aligned and is inserted in the punching 416 being formed in the humeral surface 414 of the surgical excision of patient.So Do also by the elongation sleeve 36 of no bar humeral component 10 and in the humeral surface 414 (or drill center) of the surgical excision of patient Generating layer 418/ boring 422 be aligned being formed.

Once no bar humeral component 10 is positioned in punching 416 and generating layer 418/ boring 422 by this way, surgery is cured It is born with using surgery mallet, sledgehammer or other percussion tools come the metallic plate 90 of striking impact shank 80, will no bar humerus portion Part 10 is driven in bone tissue, until no bar humeral component 10 is seated in the humeral surface of the plane surgical excision of patient completely On 414.Surgeon can observe the humeral surface 414 of surgical excision using watch window 30, to guarantee no bar humerus portion The complete seating of part 10 is thereon.

Then, surgeon will no bar humeral component 10 discharge from implant insertion instrument 330.Do so, surgeon The locking lining ring 362 that implant is inserted instrument 330 rotates counterclockwise to its unlocked position from its latched position.Locking lining ring 362 this rotation causes implant to insert each cam follower 354 of the lock arm 352 of instrument along its corresponding cam Surface 368 is travelling upwardly from the side of its outer end 372 to its inner end 370.This is done so that cam follower 354 along court Direction motion each other, thus causes lock arm 352 to pivot so that locking pawl 356 moves along direction away from each other.Lock Determine ratchet 356 along direction away from each other this move cause locking pawl 356 be released in no bar humeral component The antelabium 74 of the undercutting 70 being formed in the lower surface 18 of support flange 14, thus no bar humeral component 10 will insert work from implant Tool 330 release.As shown in figure 34, then shank 80 is impacted in surgeon's lifting, thus lifting implant insertion instrument 330, from And expose the no bar humeral component 10 of implantation.

Once no bar humeral component 10 has been implanted within the surface 414 of the surgical excision of humerus 400, surgeon can To execute the compatibility test of final humeral head part 12.Do so, surgeon is by the test head part 210 of suitable dimension (size selecting during more early test procedure) is installed to the no bar humeral component 10 of implantation.Surgeon passes through to test The center lug 218 (referring to Figure 12 and 13) of head piece 210 is inserted into the taper bore of the no bar humeral component 10 of implantation Press down in 40 and afterwards or be seated in the no bar of implantation in other words to push test head part 210 completely until it In humeral component 10, test head part 210 is arranged in the no bar humeral component 10 of implantation.The annular of center lug With the 222 side walls frictionally engaging taper bore 40, center lug to be frictionally fixed to the no bar humerus portion of implantation Part 10, and thus test head part 210 is frictionally fixed to the no bar humeral component 10 of implantation.Then, surgeon Using test head part 210 to assess the scope of level of coverage, soft tissue tension and motion.

Once surgeon is satisfied with, test head part 210 is just removed, and is replaced by final humeral head part 12.Specifically, as shown in figure 35, next the humeral head part 12 of suitable dimension (is walked by surgeon in relatively early test The size selecting during rapid) it is installed to the no bar humeral component 10 of implantation.Surgeon passes through the cone of humeral head part 12 Shape column 42 is inserted into humeral head portion in the taper bore 40 (referring to Figure 36) of elongation sleeve 36 of no bar humeral component Part 12 is arranged in the no bar humeral component 10 of implantation.

Head impact instrument 380 can be used to be impacted, and thus head piece 12 is conically locked onto no bar humerus Part 10.Do so, as shown in figure 35, by being inserted into the connector of head impact instrument by the D-shaped connecting pin 104 of shank Until an antelabium 392 of connector passes through to impact the locking pawl of the attachment means 86 of shank in 384 circular open 386 102 (referring to Fig. 6 and 7) are engaged so that head impact instrument 380 is fixed to impact shank 80, and surgeon is first by head Portion's percussion tool 380 is fixed to impact shank 80.

Then, surgeon's positioning impact shank 80 is so that the concave impulse surface 396 of head impact instrument is placed with Contact with the substantially exterior semi-spherical surface of head piece 12.Then, surgeon is hit using surgery rod, hammer or other percussion tool Beat the metal beater plate 90 of impact shank, drive humeral head part 12 with downward, thus the taper by humeral head part 12 Column 42 is urged to and defines the sidewall contact of the taper bore 40 extending sleeve 36, thus by humeral head part 12 taper Lock onto no bar humeral component 10.This final group of humeral head part 12 and no bar humeral component 10 is shown in Figure 36 Dress.

With reference now to Figure 37, show that implant inserts another embodiment of instrument 540, it can be fixed to no bar humerus Part 10, in the humeral surface 414 that the surgery being implanted to patient in order to no bar humeral component 10 prepares.Implant inserts instrument 540 include main body 542, and this main body has the elongation bore hole 544 running through extension.Securing rod 548 is trapped in hole 544.At this In the arrangement of sample, securing rod 548 rotates freely in hole 544.

Knob 550 is fixed on the proximal end of securing rod 548.Except being fixed to for implant is inserted instrument 540 No outside bar humeral component 10, knob 550 also serves as shock surface.It is, surgeon impacts the upper surface of knob 550 552, in the bone tissue of the humeral surface 414 that the surgery that no bar humeral component 10 is driven into patient prepares.

Securing rod 548 has one group of locking screw thread being formed in its distal end (i.e. the end relative with knob 550) 556.Being dimensioned so as to of screw thread 556 receives the threaded bore being formed in the elongation sleeve 36 of no bar humeral component 10 In 48 complementary threads 50.As surgeon or other user's turn knob 550, the screw thread 556 of lock screw equally revolves Turn.Rotation (for example clockwise) can be used to implant be inserted instrument 540 tensioning and is thereby fixed to no bar in one direction Humeral component 10, rotation (for example counterclockwise) in opposite direction is used for for implant inserting instrument 540 from no bar humeral component 10 loosen and thus disengage.

Figure 37 can see, multiple straight troughs or spine 558 be formed at implant insert instrument main body 542 close In the end of knob 550 of securing rod 548.Spine 558 is used as holder, to allow surgeon to plant in no bar humeral component 10 Implant insertion instrument 540 is kept during entering.

Implant insert instrument the screw thread 556 of the approach locking bar 548 of main body 542 end have be formed at therein Be aligned lining ring 560.Be aligned lining ring 560 is presented as the ring that the longitudinal axis of the main body 542 inserting instrument from implant stretches out Shape flange.Be aligned lining ring 560 has the multiple projections extending downwardly from its lower surface 564 or alignment keys 562.Can in Figure 37 To see, the size of alignment keys 562, shape and position are set to and receive the watch window being formed in no bar humeral component 10 In 30.In the case that alignment keys 562 are positioned in watch window 30, no bar humeral component 10 is prevented from being unable in implantation Insert instrument 540 with respect to implant during knob 550 rotation of thing insertion instrument to rotate, thus allow implant insertion instrument Screw thread 556 engage the screw thread 50 of (or depart from) no bar humeral component.

Using with similar mode in above-mentioned Figure 33, surgeon by no bar humeral implant 10 be fixed to implant insertion Instrument 540, then utilizes implant to insert instrument 540 by the leg 16 of no bar humeral component and elongation sleeve 36 respectively with outside The punching 416 being formed in the humeral surface 414 of section's excision and generating layer 418/ boring 422 be aligned.Once no bar humeral component 10 with This mode be positioned at punching 416 and generating layer 418/ boring 422 in, surgeon just utilize surgery mallet, sledgehammer or other Percussion tool, to impact the upper surface 552 of knob 550, no bar humeral component 10 is driven in bone tissue, until the no bar upper arm Osteogenic section 10 is seated on the humeral surface 414 of the plane surgical excision of patient completely.Surgeon can utilize watch window 30 observing the humeral surface 414 of surgical excision, to guarantee that no the complete seating of bar humeral component 10 is thereon.

Each part (such as its main body 542 and securing rod 548) that implant inserts instrument 540 can be by medical grade metal structure Become, such as stainless steel, cochrome or titanium, although equally can be using other metal or alloy.Additionally, in certain embodiments, Also the rigid polymer of such as polyethers ether copper (PEEK) etc can be used.

With reference now to Figure 38, show that implant inserts another embodiment of instrument 580.Implant inserts instrument 580 No bar humeral component 10 can be fixed to, in the humeral surface that the surgery being implanted to patient in order to no bar humeral component 10 prepares. Implant insertion instrument 580 includes main body 582, and this main body has the elongation bore hole 584 running through extension.Such as lock screw 588 Securing rod be trapped in hole 584.In such an arrangement, lock screw 588 rotates freely in hole 584, but is hindered Only it is unable to remove (being that the main body 582 that it can not insert instrument from implant removes) from hole 584.

Have in the proximal end of lock screw 588 and be formed at D-shaped drive head 590 therein, in its relative distally End has and is formed at multiple locking screw thread 592 therein.Being dimensioned so as to of screw thread 582 receives in no bar humerus portion In the complementary threads 50 of threaded bore 48 being formed in the elongation sleeve 36 of part 10.The size of D-shaped drive head 590, shape and Position is set to the D-shaped head receiving ratchet or other surgical technique and tools.So, when the head of ratchet is inserted into implant insertion work In the drive head 590 of tool and when rotating, the screw thread 592 of lock screw equally rotates.Rotation (for example clockwise) in one direction Turn and can be used to implant be inserted instrument 580 tensioning and is thereby fixed to no bar humeral component 10, in opposite direction (for example Counterclockwise) rotation is used for implant insertion instrument 580 is loosened from no bar humeral component 10 and thus disengaged.

The end that implant inserts the drive head 590 of the close lock screw 588 of main body 582 of instrument has and is formed at Passage 596 therein.The side wall that the formation of the main body 582 of implant insertion instrument has passage 596 defines along passage 596 The undercutting 598 that length extends.The form of antelabium 602 is taken in undercutting 598, and this antelabium is positioned at the top of passage 596.Antelabium 602 locking pawls 102 passing through to impact the attachment means 86 of shank are engaged (referring to Fig. 6 and 7), and implant is inserted work Tool 580 is fixed to impact shank 80.

Using with similar mode in above-mentioned Figure 33, surgeon by implant insert instrument 580 be fixed to impact shank 80, and afterwards by no bar humeral implant 10 be fixed to implant insertion instrument 580, or vice versa as the same.Then, surgeon By the leg 16 of no bar humeral component and extend sleeve 36 and shape in the humeral surface 414 of surgical excision using impact shank 80 The punching 416 becoming and generating layer 418/ boring 422 be aligned.Once no bar humeral component 10 be positioned at by this way punching 416 with And generating layer 418/ boring 422 in, surgeon just using surgery mallet, sledgehammer or other percussion tools come striking impact shank 80 Metallic plate 90, no bar humeral component 10 is driven in bone tissue, until no bar humeral component 10 is seated in patient completely The humeral surface 414 of plane surgical excision on.Surgeon can observe the humerus of surgical excision using watch window 30 Surface 414, to guarantee that no the complete seating of bar humeral component 10 is thereon.

Each part (such as its main body 582 and lock screw 588) that implant inserts instrument 580 can be by medical grade metal structure Become, such as stainless steel, cochrome or titanium, although equally can be using other metal or alloy.Additionally, in certain embodiments, Also the rigid polymer of such as polyethers ether copper (PEEK) etc can be used.In other embodiments, implant insertion instrument 580 can To be formed as single unitary member.In such embodiments, implant insertion instrument 580 can be threadably connected to implant On, or be gripped to be threadably connected on implant on impact shank.In other embodiments, implant insertion instrument 580 May include the connection lining ring driving pod around D-shaped.So, D-shaped drives pod 630 can rotate with respect to connecting lining ring.

With reference now to Figure 39 and 40, show that implant inserts another embodiment of instrument 620.Implant inserts instrument 620 can be fixed to no bar humeral component 10, the humeral surface that the surgery being implanted to patient in order to no bar humeral component 10 prepares In 414.Implant inserts the main body 622 that instrument 620 includes circularizing to a certain extent, has and extends through its main body 622 The upper hole 624 of upper part and extend through its main body 622 low portion bottom hole 626.Two holes 624,626 that This coaxial (being the central axis of their share common).Securing rod 628 is trapped in hole 624,626.In such an arrangement, Securing rod 628 rotates freely in hole 624,626, but being prevented from being unable to removing from hole 624,626 (is that it can not be from The main body 622 that implant inserts instrument removes).

Have in the proximal end of securing rod 628 and be formed at D-shaped driving pod 630 therein, in its relative distal end portion Portion has and is formed at multiple locking screw thread 632 therein.Being dimensioned so as to of screw thread 632 receives in no bar humeral component In the complementary threads 50 of threaded bore 48 being formed in 10 elongation sleeve 36 (referring to Fig. 5).The size of D-shaped driving pod 630, Shape and position are set to the D-shaped connecting pin 104 (referring to Fig. 6) receiving the attachment means 86 impacting shank 80.

Figure 39 and 40 can see, the circumferential body 622 that implant inserts instrument 620 includes connecting lining ring 634, should The D-shaped connecting lining ring around securing rod 628 drives pod 630.So, the D-shaped of securing rod 628 drives pod 630 relative The connection lining ring 634 inserting the circumferential body 622 of instrument in implant rotates.The outer surface connecting lining ring 634 has and is formed at Multiple ratchet slit 636 therein.The one end 638 of ratchet slit 636 is wider than its other end 640, so that ratchet is narrow 636 one-tenth generally L-shaped constructions of groove.Define that the side wall 642 in the narrow end portion 640 of ratchet slit 636 defines slope shape or with other The cam face 644 that mode tilts, and define that the side wall 646 in the wide end portion 638 of ratchet slit 636 defines vertical backstop table Face 648.When the connecting pin 104 impacting shank is inserted in implant and inserts in the D-shaped driving pod 630 of instrument, impact shank The locking pawl 102 (referring to Fig. 6 and 7) of attachment means 86 be positioned in a ratchet slit 636.The structure of ratchet slit 636 Make and allow impact shank 80 (and by this securing rod 628) to insert the circumferential body 622 of instrument 620 along one with respect to implant Direction rotation (for example clockwise), but prevent rotation (for example counterclockwise) in opposite direction.Specifically, impact shank 80 (and by this securing rod 628) rotation along clockwise direction causes the attachment means impacting shank with respect to circumferential body 622 The leading edge contact ramp shaped cams surface 644 of 86 locking pawl 102 (referring to Fig. 6 and 7), this ramp shaped cams surface limits Wherein capture has the narrow end portion 640 of the ratchet slit 636 of locking pawl 102.Continue to turn clockwise and cause locking pawl 102 Travel upwardly (when the spring biasing that spring impacts the 110 of shank is overcome) along ramp shaped cams surface 644, and leave Ratchet slit 636.Locking pawl 102 row between two adjacent ratchet slits 636 on the outer surface connecting lining ring 634 Enter, until the back edge of locking pawl 102 leave adjacent with the vertical stop surface just being exited by locking pawl 102 The vertical stop surface 648 of ratchet slit 636, at this point, spring impacts the spring biasing of the 110 of shank by locking pawl 102 push down in ratchet slit 636.

Conversely, impact shank 80 (and by this securing rod 628) rotation in the counterclockwise direction with respect to circumferential body 622 The leading edge causing the locking pawl 102 (referring to Fig. 6 and 7) of attachment means 86 of impact shank contacts the perpendicular of ratchet slit 636 Straight stop surface 648, this vertical stop surface defines that wherein capture has the wide end portion of the ratchet slit 636 of locking pawl 102 638.Prevent from impacting shank 80 (and by this securing rod 628) with respect to annular master with this contact of vertical stop surface 648 Body 622 further rotates in the counterclockwise direction.

Impact shank 80 (and by this securing rod 628) turns clockwise with respect to this ratchet type of circumferential body 622 It is used for for no bar humeral component 10 being fixed to implant insertion instrument 620.Specifically, insert when impact shank 80 is arranged on implant When entering on instrument 620 and rotating, the screw thread 632 of securing rod equally rotates.Rotation (for example clockwise) can be used in one direction Implant is inserted instrument 580 tensioning and is thereby fixed to no bar humeral component 10.In opposite direction (for example counterclockwise) Rotation is used for implant insertion instrument 620 is loosened from no bar humeral component 10 and thus disengaged.In order to carry out such inverse time Pin rotates, and the actuator arm 98 of the lever 94 in impact shank for the surgeon presses down on and keeps, thus by impact shank Locking pawl 102 lifts off the ratchet slit 636 that implant inserts instrument 620.

The end that implant inserts the screw thread 632 of the approach locking bar 628 of circumferential body 622 of instrument has and is formed at it In be aligned lining ring 652.Be aligned lining ring 652 is presented as and is formed in the distal end 654 of the main body 622 that implant inserts instrument Annular flange flange.Be aligned lining ring 652 has the multiple projections extending downwardly from its lower surface 658 or alignment keys 656.In Figure 40 Can see, the size of alignment keys 656, shape and position are set to and receive the observation window being formed in no bar humeral component 10 In mouth 30.In the case that alignment keys 656 are positioned in watch window 30, no bar humeral component 10 is prevented from being unable to planting Insert instrument 620 with respect to implant during securing rod 628 rotation entering thing insertion instrument to rotate, thus allow implant insertion The screw thread 632 of instrument engages the screw thread 50 of (or disengaging) no bar humeral component.

Using with similar mode in above-mentioned Figure 33, surgeon by implant insert instrument 620 be fixed to impact shank 80, and afterwards no bar humeral implant 10 is fixed to implant insertion instrument 620.Then, surgeon is using impact handle Portion 80 by the leg 16 of no bar humeral component and extends sleeve 36 and the punching being formed in the humeral surface 414 of surgical excision 416 and generating layer 418/ boring 422 be aligned.Once no bar humeral component 10 is positioned at punching 416 and generating layer 418 by this way In, surgeon just using surgery mallet, sledgehammer or other percussion tools come the metallic plate 90 of striking impact shank 80, will No bar humeral component 10 is driven in bone tissue, until no bar humeral component 10 is seated in the plane surgical excision of patient completely On humeral surface 414.Surgeon can observe the humeral surface 414 of surgical excision using watch window 30, to guarantee no The complete seating of bar humeral component 10 is thereon.

Each part (such as its main body 622 and securing rod 628) that implant inserts instrument 620 can be by medical grade metal structure Become, such as stainless steel, cochrome or titanium, although equally can be using other metal or alloy.Additionally, in certain embodiments, Also the rigid polymer of such as polyethers ether copper (PEEK) etc can be used.

With reference now to Figure 41 and 42, show another embodiment of head resection guide 670, it can be used as cutting and draws Guiding element, to guide bone saw blade to advance, thus excise the humeral head of patient.Cut with above in relation to the head described in Figure 17-19 Except, unlike guiding piece 290, head resection guide 670 is uncontrollable, but it is configured with the chi of multiple changes Very little (diameter changing), to coordinate the needs of given patient.Head resection guide 670 includes the base portion 672 of general rectangular, This base portion has the circular rings 674 being fixed to the upper.Ring 674 stretches out from base portion 672, and defines circular open 676. As described in more detail below, the humeral head of patient is trapped in opening 676 during its excision.

Head resection guide 670 has connector 678, and this connector can be by being directed at the attachment means of shank 120 126 are engaged, and head resection guide 670 is fixed to be aligned shank 120.Connector 678 have be formed at therein Key hole shaped opening 680.The distal end being sized and shaped to the main body 122 in be aligned shank for the reception of keyhole opening 680 The key pin 144 of middle formation.Also have in connector 678 and be formed at passage 682 therein.Undercutting 684 is along the length of passage 682 Formed.The form of antelabium 686 is taken in undercutting 684, and this antelabium is positioned at the top of passage 682 and extends outwardly into passage In 682.The locking pawl 142 (referring to Fig. 8 and 9) that antelabium 686 passes through to be aligned the attachment means 126 of shank is engaged, will Head resection guide 670 is fixed to be aligned shank 120.

The base portion 672 of head resection guide has and is formed at multiple pin-and-hole 692 therein.As described in more detail below , surgery pin is inserted through pin-and-hole 692, so that by head resection guide during the natural humeral head excision of patient 670 are fixed to the humerus of patient by pin.

Figure 42 can see, base portion 672 and ring 674 both of which include plane surface, and plane surface coordinates to limit Cutting guidance surface, this cutting guidance surface is used for guiding bone saw blade to excise the natural humeral head of patient.Specifically, Base portion 672 includes guidance surface 694 before plane, before this plane guidance surface be aligned to the plane of ring 674 after guidance surface 696 Become relation of plane altogether.As described above, in exemplary embodiment as herein described, head resection guide 670 embodies and is integrated Change structure.Thus, two guidance surfaces 694,696 are presented as common surface, collectively define cutting surfaces, in order to excise trouble During the cutting operation of natural humeral head of person, bone saw blade can support (guiding) on this cutting surfaces.

In use, by the key pin 144 being formed in the distal end of the main body 122 of be aligned shank is inserted into head In the keyhole opening 680 of the connector 678 of resection guide, head resection guide 670 is installed to be aligned handle by surgeon Portion 120.Do so, the antelabium 686 of connector pass through to be aligned the attachment means 126 of shank locking pawl 142 (referring to Fig. 8 and 9) engaged, thus head resection guide 670 is fixed to be aligned shank 120.

Using with above in relation to the similar mode described in Figure 26, surgeon is next by head resection guide 670 As cutting guiding piece, in order to the surgical excision of the humeral head 402 of patient.Do so, surgeon is using be aligned shank Head resection guide 670 is positioned so that the rear section 702 of ring 674 is resisted against patient by 120 around the humeral head 402 of patient Rotation muscle group rear muscle group insertion site on.Do so rotates muscle group after protecting during head excision, and is used as to draw Guiding element is placed on the step at correct height and pattern.Then, surgeon by the front guidance surface 694 of base portion 672 with respect to The front surface 404 of the humerus 400 of patient is positioned at desired excision angle and height.Then, surgeon can be to base portion Front surface carry out with respect to the position at joint edge with respect to front surface 404 and front guidance surface 694 any necessary micro- Minor adjustment, to be finally reached desired excision angle and height.Afterwards, surgeon can be by surgery pin 406 (referring to Figure 26) It is inserted through each pin-and-hole 692, head resection guide 670 is fixed to the humerus 400 of patient by pin, thus will be leading Draw surface 694 to be maintained in its desired locations.Once pin is solid in place, be aligned shank 120 is just drawn by surgeon from head excision Guiding element 670 separates.

With similarly, next surgeon operates bone saw for described in Figure 26, for example, shake power saw 408, to cut Humeral head 402 except patient.Do so, the saw blade 410 of power saw 408 is positioned at head resection guide by surgeon The plane of base portion 672 before on guidance surface 694.Then, surgeon activates concussion power saw 408 and applies pressure thereon Power is so that it is advanced to backward contacts with the front surface 404 of the humerus 400 of patient.When saw blade 410 is advanced into and humerus backward 400 front surface 404 contact and afterwards along the direction towards surface 412 thereafter pass through part when, the shake of bone saw 408 Swing the bone tissue that humeral head 402 is ground in motion.

Surgeon makes power saw 408 continue to advance backward, until saw blade 410 leaves bone.Specifically, surgeon Continue operation bone saw 408, until the distal end of its blade 410 exceedes the rear surface 412 of humeral head 402.After bone In the case that surface 412 is left, saw blade 410 is supported and is guided by the rear guidance surface 696 of ring 674.So, after ring 674 Guidance surface 696 prevents saw blade 410 from contacting the rear rotation muscle group of patient.Once saw blade 410 has been moved off bone and advances To on the rear guidance surface 696 of ring 674, surgeon just can disable bone saw 408, lifts off the humeral head of patient afterwards 402 cut-out.

Head resection guide 670 can be made up of medical grade metal, such as stainless steel, cochrome or titanium, although equally Can be using other metal or alloy.Additionally, in certain embodiments, it is possible to use the rigidity of such as polyethers ether copper (PEEK) etc Polymer.

With reference now to Figure 43 and 44, show another embodiment of no bar humeral component 10.Reality shown in Figure 43 and 44 The feature applying example is substantially similar to those features that the embodiment above with reference to Fig. 1-5 is discussed.This in Figure 43 and 44 Feature is designated as identical with those drawing reference numeral used in Fig. 1-5.Generally, in addition to several differences, figure 43 is substantially the same with the embodiment of Fig. 1-5 with 44 embodiment.For example, sewing hole 26 is from the no bar humerus of Figure 43 and 44 Part removes.In this case, surgeon can replace the sewing hole 26 removing with watch window 30, by osteocomma or Suturing soft tissue is to no bar humeral component 10.In order to adapt to this purposes of watch window 30, the support of no bar humeral component is convex Edge 14 define that the edge of watch window 30 can be rounded.

With reference now to Figure 45 and 46, show another embodiment of sizing apparatus 160.Embodiment shown in Figure 45 and 46 Feature be substantially similar to those features that the embodiment above with reference to Figure 10 and 11 is discussed.This spy in Figure 45 and 46 Levy be designated as identical with those drawing reference numeral used in Figure 10 and 11.Generally, in addition to several differences, figure 45 is substantially the same with the embodiment of Figure 10 and 11 with 46 embodiment.For example, watch window 180 is from Figure 45 and 46 determine Footpath apparatus 160 removes.

Additionally, the geometry of drift guide hole 170 is altered.Specifically, the sizing apparatus shown in Figure 45 and 46 In 160 embodiment, drift guide hole 170 is generally T-shaped.So, the geometry of drift guide hole 170 is closer right Should be in the geometry of the T-shaped pointed tooth 252 of surgery drift 240.

Additionally, in the embodiment of sizing apparatus 160 shown in Figure 45 and 46, the geometry of connector 182 becomes Change.In order to adapt to this change, the attachment means 126 of be aligned shank 120 can also change, and sizing apparatus 160 is fixed to Thereon.

With reference now to Figure 47, show another embodiment of surgery drift 240.The feature base of the embodiment shown in Figure 47 Those features being discussed similar to the embodiment above with reference to Figure 14 in basis.This feature in Figure 47 is designated as and Figure 14 Used in those drawing reference numeral identical.Generally, in addition to several differences, the embodiment of Figure 47 and the reality of Figure 14 Apply example substantially the same.For example, center spike 262 removes from the surgery drift 240 of Figure 47.In this case, surgery Doctor can be holed in the humerus of the surgery preparation of patient using centre drill 270, thus adapting to no bar humerus in the above described manner The elongation sleeve 36 of part 10.

Additionally, pillar 268 has been removed so that pointed tooth 252 is more formed on the main body 242 of surgery drift In.Additionally, in the embodiment of surgery drift 240 shown in Figure 47, the connection pod 260 of surgery drift and interface channel 246 Geometry altered.In order to adapt to this change, the attachment means 86 of impact shank 80 can also change, by surgery Drift 240 is fixed to the upper.

Additionally, can see in Figure 47, the proximal end 266 of each flank 256 of pointed tooth 252 (is fixed to drift Axle 244 end) wider than the relative distal end 288 of each flank 256.So, the humerus preparing in the surgery of patient The correspondingly-shaped of the punching of middle formation is wider than at its blind bore end at its open end.This opening broadening is easy to no bar The insertion of the cantilevered leg 16 of humeral component 10.

With reference now to Figure 48, show that implant inserts another embodiment of instrument 540.Embodiment shown in Figure 48 Feature is substantially similar to those features that the embodiment above with reference to Figure 37 is discussed.This feature in Figure 48 is designated as Identical with those drawing reference numeral used in Figure 37.Generally, in addition to several differences, the embodiment of Figure 48 and figure 37 embodiment is substantially the same.For example, the size of knob 552 is larger in the embodiment of Figure 48, in order to by surgeon Use.Additionally, implant inserts the holder overmolding of instrument in the main body 542 of instrument.

With reference now to Figure 49-52, show brill guide 710, its can be used to no bar humeral component 10 implantation it The humeral surface that the front surgery to patient prepares carries out prebored hole.In this case, surgeon can select subsequently no Before bar humeral component 10, (i.e. using surgery drift 240 after such prebored hole) is accurate to the surgery of patient in the above described manner Standby humeral surface is punched out.Alternatively, the humeral surface that surgeon can prepare to the surgery of patient Holed, to replace punching program.

As described above, no bar humeral component 10 can be arranged to various sizes (i.e. diameter), to coordinate the need of given patient Will.For example, no bar humeral component 10 can be configured with nine kinds of different sizes.In such various sizes of part 10 Each there is the leg of different-thickness and length.So, if discrete brill guide is used for each various sizes of nothing Bar humeral component 10, then multiple various sizes of brill guide (such as nine kinds various sizes of no bar humeral component will be needed 10 will need nine kinds of various sizes of brill guides).Additionally, in order to avoid blocked up bores the no bar that guide is used for reduced size Humeral component 10 is it may be necessary to multiple different bore size.As described in more detail below, bore guide 710 to avoid Need such various sizes of brill guide and brill.

Bore guide 710 and include main body 712, this main body has generally flat lower surface 714 and relative step Upper surface 716.Figure 49 can see, the upper surface 716 of step is spiral, and have included due to step many Individual discrete generally flat brill stop surface 718.Each bores the lower surface of stop surface 718 and the main body 712 boring guide 714 are spaced apart different length.Therefore, the main body 712 boring guide is stopped from different each brills in stop surface 718 that bores Gear surface has different thickness at corresponding position.

Figure 49 and 50 can see, each bores stop surface 718 and has and be formed at multiple guiding bore hole therein 730.Guiding bore hole 730 is configured to guide Periphery bit 272 during the boring of the humeral surface that the surgery of patient prepares.This Sample, each guiding bore hole 730 extends through the whole thickness of guide body 712.In other words, the one of each guiding bore hole 730 Brill stop surface 718 is led in end, and lower surface 714 is led in the other end.As described above, the lining ring 284 of Periphery bit 272 is used Make depth stop part, with guarantee drill bit 272 get out at desired depth surgery preparation hole.So, Periphery bit 272 can push away Enter by a guiding bore hole 730, and enter bone tissue, until in other words the lower surface 286 of lining ring 284 is preferably minimized or Engage the brill stop surface 718 of selection.

Each bores stop surface 718 and corresponds to various sizes of no bar humeral component 10.For example, in spirality step Brill stop surface 720 at " bottom " end 722 on surface 716 corresponds to maximum sized no bar humeral component 10, in spiral Brill stop surface 724 at " top " end 726 of shape step upper surface 716 corresponds to the no bar humeral component of minimum dimension 10.The remaining stop surface 718 that bores corresponds to the no bar humeral component 10 being left size, and the size of corresponding component 10 is along step The upper surface 716 of formula is being increased up from the side of its top ends 726 to its bottom end 722.

Because each bores stop surface 718 and is spaced apart different length from the lower surface 714 of the main body 712 boring guide, So the brill stop surface 718 being used according to surgeon, the humeral surface that the surgery getting into patient is prepared by Periphery bit 272 Different depth.For example, if surgeon is using the brill at " top " end 726 of spirality step upper surface 716 The guiding bore hole 730 of stop surface 724, then the hole being got out will utilize in spirality step upper surface than in surgeon The hole getting out in the case that stop surface 720 guides bore hole 730 is shallow for boring at 716 " bottom " end 722, and reason is drill bit 272 lining ring 284 will drop before it is preferably minimized on the brill stop surface 720 of bottom positioning on brill stop surface 724 To minimum.So, drill bit 272 along step upper surface 716 in the direction from its top ends 726 to its bottom end 722 On bore stop surface 718 bore hole will gradually deepen.

Figure 50 and 51 can see, each bores the guiding bore hole 730 of stop surface 718 with respect to remaining brill backstop Surface 718 is arranged to the hole pattern of uniqueness.For example, corresponding with maximum sized no bar humeral component 10 in spirality step Brill stop surface 720 at " bottom " end 722 of formula upper surface 716 has larger hole pattern, and (i.e. guiding bore hole 730 is relative In other holes, pattern more stretches), and corresponding with the no bar humeral component 10 of minimum dimension in spirality step upper table Brill stop surface 724 at " top " end 726 in face 716 has less hole pattern, and (i.e. guiding bore hole 730 is with respect to other Hole pattern is compacter).So, hole pattern corresponds to the chi of the cantilevered leg 16 of various sizes of no bar humeral component 10 Very little, larger hole pattern corresponds to larger part leg 16, and less hole pattern corresponds to less part leg 16.Also It is to say, bores the size that stop surface 718 corresponds to no bar humeral component 10, the size of corresponding component 10 is along the upper table of step Face 716 is being increased up from the side of its top ends 726 to its bottom end 722.

Figure 49 and 51 can see, guide body 712 has elongated protuberance 732, this elongated protuberance is fixed to Its lower surface 714 and extending downwardly from this lower surface.Elongated protuberance 732 is configured to receive sizing apparatus 160 Elongation bore hole 168 in, by bore guide 710 be fixed to the upper.Elongated holder 734 is fixed to step upper surface 716, And upwardly extend from this upper surface.Holder 734 has and is formed at multiple groove 736 therein, and is made by surgeon With boring guide 710 to grasp.

As shown in figure 51, guide body 712 has the multiple alignment keys 738 being formed in its lower surface 714.Alignment keys 738 receive in the multiple aligned slots 740 being formed in the side wall of the elongation bore hole 168 (referring to Figure 52) of sizing apparatus, with The correct stop surface 718 that bores is associated with the sizing apparatus 160 of just size.Specifically, each various sizes of sizing The aligned slots 740 of apparatus 160 be placed on for specific sizing apparatus 160 in unique annular location (be each not There is the slot configuration of uniqueness with the sizing apparatus of size).When the alignment keys 738 boring guide 710 are advanced to unique positioning When in aligned slots 740, the correct brill stop surface 718 corresponding with the sizing apparatus 160 in specific footpath will be located into sizing On one pilot punch hole 170 of apparatus, thus step upper surface 716 key boring guide 710 is coupled to specific footpath Sizing apparatus 160.

Similar with other apparatus as herein described, boring guide 710 can be constructed by biocompatibility metal, such as stainless Steel, cochrome or titanium, but other metal or alloy can be used.Bore guide 710 and may be embodied in polymer devices.This Sample, bores guide 710 and can be made up of any suitable medical grade polymer material, such as polyether-ether-ketone (PEEK).Such In embodiment, polymer bores guide 710 and may include the metal insert (such as sleeve) being positioned in brill guiding bore hole 730.

In operation, surgeon can be got out using boring in the humeral surface that the surgery in patient for the guide 710 prepares Multiple holes.Do so, surgeon selects the no bar humeral component in the humerus be implanted to patient first in the above described manner 10 size.Such rotation in operation propulsion row, or can be operated due to the inherence of the use based on sizing apparatus 160 Change and carry out.Then, surgeon by the sizing apparatus 160 corresponding with the no bar humeral component 10 of selected size with above-mentioned The surgery being fixed to the humerus of patient with regard to the mode described in Figure 27 prepares surface.

Then, surgeon is from the multiple brill stop surfaces 718 being formed the step upper surface 716 boring guide Select the brill stop surface 718 of the brill guide 710 corresponding with the no bar humeral component 10 of selected size.Then, by inciting somebody to action The elongated protuberance 732 boring guide is advanced in the elongation bore hole 168 of sizing apparatus 160, and surgeon can will bore guiding Device 710 is attached to sizing apparatus 160.During such propulsion, the alignment keys 738 boring guide 710 are advanced to sizing apparatus In 160 aligned slots 740 of unique positioning, so that the brill backstop corresponding with the specific footpath of selected sizing apparatus 160 Surface 718 is positioned on a pilot punch hole 170 of sizing apparatus.

Then, surgeon can make periphery bore 272 and be advanced through selected each guiding bore hole boring stop surface 718 730, and enter in bone tissue, until the lining ring 284 of drill bit is preferably minimized or in other words engages the brill backstop table of selection Face 718.Then, surgeon can be with rotary drilling guide 710 so that the brill stop surface 718 selecting be positioned at sizing apparatus On a different drift guide in 160 remaining drift guide hole 170.Afterwards, surgeon makes periphery bore 272 propulsions Guide bore hole 730 through each, and repeat this process at each of remaining drift guide hole 170 drift guide.

Then, surgeon can be to utilize surgery drift 240 with above with respect to the similar mode described in Figure 29, with right The surgery of the present prebored hole of the humerus of patient prepares surface and is punched out, afterwards with above with respect to similar described in Figure 33 Mode implants no bar humeral component 10.Alternatively, in the case of not first with surgery drift 240, surgery The surgery that no bar humeral component 10 can be implanted to the boring of humerus of patient by doctor prepares in surface.

Although illustrate and describing the disclosure in detail in accompanying drawing and described above, such diagram and describe Should be regarded as exemplary rather than restricted it should be appreciated that only illustrate and describing exemplary embodiment, and this All changes in bright essential scope and modification all should be protected.

The present invention has the multiple advantages producing from multiple features of devices, systems and methods described herein.Should note Meaning, assembly of the invention, the alternatively embodiment of system and method may not include described all features, but still can To benefit from least some of advantage of this category feature.Those of ordinary skill in the art can easily design their own Being embodied as of devices, systems and methods, this is embodied as in conjunction with one or more in feature of present invention, and to fall In the spirit and scope of the invention.

Claims

1. a kind of plastic surgery shoulder prosthesis of the humeral head of the humerus for replacing patient, including：

Humeral head part, described humeral head part includes：(i) substantially hemispheric supporting surface；(ii) with described supporting The back surface of surface opposite pair；And (iii) is formed at the taper locking mechanism in described back surface, and

No bar humeral component, described no bar humeral component includes：(i) round flange, the diameter of round flange and the described head of humerus The diameter of the back surface of portion's part is substantially the same；(ii) it is formed at the taper locking mechanism in described round flange, described The taper locking mechanism of no bar humeral component is configured to engage the taper locking mechanism of described humeral head part, to make institute State humeral head part and the taper locking each other of described no bar humeral component, and (iii) multiple cantilevered leg, the plurality of Cantilevered leg laterally extends outwardly away from the described lower surface of described round flange, wherein, in the plurality of cantilevered leg Each there is one end, described one end is fixed to the described lower surface of described round flange.

2. plastic surgery shoulder prosthesis according to claim 1, wherein：

The taper locking mechanism of described humeral head part includes laterally extending outwardly away from the tapered stud of described back surface,

The taper locking mechanism of described no bar humeral component includes extending sleeve, and described elongation sleeve is fixed to described round flange Lower surface and laterally extend outwardly away from the lower surface of described round flange, and

Described elongation sleeve has and is formed at taper bore therein, and described taper bore is configured to receive described humeral head The described tapered stud of part.

3. plastic surgery shoulder prosthesis according to claim 2, wherein, in the plurality of cantilevered leg each Two ends are spaced apart with other cantilevered legs and described elongation sleeve.

4. plastic surgery shoulder prosthesis according to claim 1, wherein, being sized such that of described round flange is worked as When no bar shoulder member is fixed to the humerus of patient, its radially outward edge is positioned to connect with the cortical layer bone tissue of the humerus of patient Touch.

5. plastic surgery shoulder prosthesis according to claim 4, wherein, each in multiple cantilevered legs is in described circle The inner radial of the radially outward edge of shape flange is positioned at a position, so that patient ought be fixed to no bar shoulder member Humerus when multiple cantilevered legs in each contact with the cancellous bone tissue of the humerus of patient.

6. plastic surgery shoulder prosthesis according to claim 1, wherein, each in multiple cantilevered legs includes bone and connects Plywood, described osteosynthesis plate has and is formed at multiple serration therein.

7. plastic surgery shoulder prosthesis according to claim 6, wherein, each in described cantilevered leg also includes stretching Long flank, described elongation flank be fixed to described osteosynthesis plate and along the center towards described round flange direction from described bone Joint plate extends internally.

8. plastic surgery shoulder prosthesis according to claim 1, wherein：

Described round flange has and is formed at multiple correction slit therein, and

Each in the plurality of correction slit at the position above one of the plurality of cantilevered leg and from One of described cantilevered leg is radially outwardly positioned on described round flange.

9. a kind of plastic surgery shoulder prosthesis of the humeral head of the humerus for replacing patient, including：

Humeral head part, described humeral head part includes：(i) substantially hemispheric supporting surface；(ii) with described supporting The back surface of surface opposite pair；And (iii) laterally extends outwardly away from the tapered stud of described back surface, and

No bar humeral component, described no bar humeral component includes：(i) round flange, the diameter of round flange and the described head of humerus The diameter of the back surface of portion's part is substantially the same；(ii) extend sleeve, described elongation sleeve is fixed to described round flange Lower surface and laterally extend outwardly away from the lower surface of described round flange, described elongation sleeve have be formed at therein Taper bore, described taper bore is configured to receive the described tapered stud of described humeral head part, and (iii) is multiple Cantilevered leg, the plurality of cantilevered leg is laterally extending outwardly away from described circle with described elongation on sleeve identical direction The described lower surface of shape flange, wherein, each in the plurality of cantilevered leg has one end, and described one end is fixed Described lower surface to described round flange.

10. plastic surgery shoulder prosthesis according to claim 9, wherein, in the plurality of cantilevered leg each The second end is spaced apart with other cantilevered legs and described elongation sleeve.

11. plastic surgery shoulder prosthesis according to claim 9, wherein, being sized such that of described round flange When no bar shoulder member is fixed to the humerus of patient, its radially outward edge is positioned to the cortical layer bone tissue with the humerus of patient Contact.

12. plastic surgery shoulder prosthesis according to claim 11, wherein, each in multiple cantilevered legs is described The inner radial of the radially outward edge of round flange is positioned at a position, so that trouble ought be fixed to no bar shoulder member Each in multiple cantilevered legs during the humerus of person is contacted with the cancellous bone tissue of the humerus of patient.

13. plastic surgery shoulder prosthesis according to claim 9, wherein, each in multiple cantilevered legs includes bone Joint plate, described osteosynthesis plate has and is formed at multiple serration therein.

14. plastic surgery shoulder prosthesis according to claim 13, wherein, each edge in the plurality of serration The direction towards described round flange is angled up.

15. plastic surgery shoulder prosthesis according to claim 13, wherein, each in described cantilevered leg also includes Elongation flank, described elongation flank is fixed to described osteosynthesis plate and engages from described bone along towards the direction of described elongation sleeve Plate extends internally.

16. plastic surgery shoulder prosthesis according to claim 9, wherein：

17. plastic surgery shoulder prosthesis according to claim 9, wherein：

Described elongation sleeve has and is formed at threaded bore therein, and

Described threaded bore medially extends outwardly away from the distal end of described elongation sleeve and leads to described taper bore.

18. plastic surgery shoulder prosthesis according to claim 9, wherein, described round flange is between described elongation set Have at radial position between cylinder and the plurality of cantilevered leg and be formed at multiple watch window therein.